Quality Management Nurse Consultant - Remote

Overview

The Quality Management Nurse Consultant role at CVS Health involves auditing clinical criteria and compliance within the Medicaid and Duals Program, focusing on continual process improvement.

In Short

• Position is remote, working Monday to Friday 8:00am - 5:00pm.
• Auditing clinical criteria and policy procedures.
• Requires RN with multi-state privilege compact license.
• 3+ years clinical experience and 2+ years in Utilization Management required.
• Experience with MS Office Suite and navigating multiple systems.
• Preferred qualifications include a BSN degree and auditing experience.
• Experience in Medicaid and/or Medicare is a plus.
• Critical thinking skills are essential.
• Offers competitive salary and comprehensive benefits.
• Application window closes on 10/11/2025.

Requirements

• Current RN license with multi-state privilege.
• 3+ years of clinical experience.
• 2+ years of Utilization Management experience.
• Proficiency in MS Office Suite applications.
• Experience in auditing and managed care.
• Knowledge of Medicaid and Medicare systems.
• Critical thinking and analytical skills.
• Associates Degree required; Bachelors preferred.

Benefits

• Affordable medical plan options.
• 401(k) plan with company matching.
• No-cost wellness programs.
• Flexible work schedules and paid time off.
• Tuition assistance and financial coaching.
• Dependent care resources and family leave.
• Employee stock purchase plan.
• Confidential counseling services.