Nurse Consultant, QM
Posted 30ds ago
Employment Information
Job Description
QM Nurse Consultant developing and implementing clinical quality assurance programs at CVS Health. Ensuring compliance, analyzing data, and training clinicians.
Responsibilities:
- Develops and implements quality assurance programs and initiatives to monitor and improve healthcare services and processes
- Communicates with healthcare professionals to develop and implement quality improvement initiatives that enhance the quality and consistency of patient care
- Monitors and ensures compliance with relevant laws, regulations, and accreditation standards by conducting regular reviews, assessments, and audits to identify and address areas of non-compliance
- Contributes to the development, revision, and implementation of policies, procedures, and guidelines that focus on improving clinical quality and ensuring patient safety
- Collaborates with cross-functional teams, such as legal, clinical operations, and regulatory affairs, to ensure policies are up-to-date, aligned with industry best practices, and reflect regulatory requirements
- Analyzes data, identifies trends, and implements evidence-based practices that address areas for improvement, reduce variations in care, and enhance clinical effectiveness
- Provides training and education to healthcare professionals, staff, and stakeholders on quality assurance, patient safety, and compliance-related topics
- Contributes to enhancing healthcare services, improving patient outcomes, and ensuring adherence to regulatory requirements and industry standards
- Stays up-to-date on healthcare quality studies and evidence-based practices by participating in research efforts, contributing to scholarly publications, and/or facilitating research utilization to improve clinical care and outcomes
Requirements:
- Registered Nurse (RN) required
- 3-5 years of direct care clinical experience as an RN required
- Active and unrestricted RN licensure required in candidate's state of residence
- Working knowledge of problem solving and decision making skills
- Working knowledge of medical terminology
- Working knowledge of digital literacy skills
- Ability to deal tactfully with customers and community
- Ability to handle sensitive information ethically and responsibly
- Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option
- Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients
- 2 years’ experience with MS Office suite applications including Excel
- Strong computer skills utilizing multiple systems and applications at the same time
- Must have critical thinking skills
- Certified Professional Coder (CPC) preferred
- Experience with ICD-10, CPT coding
- Experience with QNXT
- Experience with QuickBase
- Experience with Cotiviti Editing/CXT
- Bachelor's degree preferred/specialized training/relevant professional qualification
Benefits:
- Affordable medical plan options
- a 401(k) plan (including matching company contributions)
- an employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- colleague assistance programs
- Tuition assistance
- retiree medical access
- CVS Health bonus, commission or short-term incentive program eligibility
