QM Nurse Consultant - Remote

Overview

The QM Nurse Consultant position at CVS Health involves reviewing and evaluating clinical information and documentation, ensuring compliance with regulatory and accreditation requirements.

In Short

• Responsible for clinical information review and evaluation.
• Interprets data from clinical records and applies clinical criteria.
• Coordinates clinical resolutions with clinician support.
• Acts as a resource for customer service and claims processing.
• Requires an active RN license and clinical experience.
• Must be proficient in Microsoft Office and web browsers.
• 5+ years of clinical experience required.
• 2+ years of experience as a Registered Nurse required.
• Preferred experience in Utilization Management and Managed Care.
• Offers competitive benefits and salary range.

Requirements

• Active RN license in state of residence.
• 5+ years of clinical experience.
• 2+ years of experience as a Registered Nurse.
• Experience with Utilization Management review.
• Managed Care experience preferred.
• Client processing experience is a plus.
• Proficient in Microsoft Office products.
• Ability to navigate web resources effectively.

Benefits

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