Quality Management Nurse Consultant

Job DescriptionThe QM Nurse Consultant is a work at home role. Experienced nurse will be responsible for investigating and supporting reported incidents through contractual obligations of various states, including Michigan, Ohio, and Illinois. This role involves applying best practices with administrative codes in order to improve member outcomes. Typical office working environment with productivity and quality expectations. Professional customer service demeanor a plus as nurse may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information. Commands a comprehensive knowledge of administrative codes and CMS contractual obligations of MMP program. Staff will work on a variety of electronic tools and must be comfortable with technology and Microsoft Word, Adobe Acrobat, and Windows 10. High level of accuracy and attention to detail are a must for this position. The ideal candidate is self-motivated and comfortable working under tight deadlines. Professional demeanor, good work ethic, and self-motivated Conscientious problem solver, willing to learn, takes personal pride in their work performance/accuracy Proven organizational and time management skills required Excellent verbal communication skills-clear, concise and appropriate required Experience with a variety of EMR systems highly preferred. Computer literacy and demonstrated proficiency is preferred in order to navigate through internal/external computer systems, Adobe, and MS Office Suite applications, including Word and Excel. Telework requires the ability to self-motivated and be a proactive employee. Volume and accuracy expectations will be communicated and are expected to be met. Work requires the ability to read and interpret medical record documentation, both computer-generated and handwritten. Siting at a workstation for extended periods of time typing on the computer. Ability to multi-task, prioritize and effectively adapt to a fast-paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written.Required Qualifications Active and unrestricted MI, OH, and IL or compact state RN license required 3+ years work related experience in the healthcare industry 3+ years documenting electronically using keyboard and multiple computer screens-- navigating through internal/external computer systems, and MS Office Suite applications, including Word and ExcelCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications 3+ years of quality management experience 1+ years Experience with a variety of EMR systems highly preferred.EducationAssociates degree required; BSN preferredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15