QM Nurse Consultant - Remote

Bring your heart to CVS Health. Every 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.

Position Summary

This position is within our Duals Program and is going to be auditing against the use of clinical criteria, policy procedures, and for compliance purposes.

Schedule is Monday - Friday 8:00am - 5:00pm.

Will have to maintain clinical review skills through he annual use of IRR. Will work with leadership for continual process improvement within Duals UM Program.

Required Qualifications

• RN with current unrestricted “multi-state privilege” compact license.

• 3+ years of clinical experience required.

• 2+ years of Utilization Management experience required

• 2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.).

Preferred Qualifications

• BSN degree preferred

• Auditing experience

• Managed care experience

• Medicaid and/or Medicare experience

• Systems experience: MedCompass and/or QNXT

• Critical thinking skills

• Previous experience working in a remote/virtual environment

Education

• Associates Degree required

• Bachelors preferred

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available …