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Quality Management Nurse Consultant

1 month ago

Phoenix, Arizona, United States CVS Health Full time
Job Summary

This is a full-time Quality Management Nurse Consultant opportunity within Arizona. The working schedule is Monday-Friday 7:00am-3:30pm AZT.

The ideal candidate will be responsible for obtaining, reviewing, abstracting, and data-entering medical records utilized for HEDIS supplemental data processes. They must understand the NCQA HEDIS technical specifications for the designated HEDIS supplemental data measures and be able to apply their understanding in the process to review, abstract, and data-enter supplemental data. They will collaborate with the health plan HEDIS project managers and other health plan departments to achieve the common goal of improving member outcomes, as measured by the HEDIS/STAR measures.

The QM Nurse Consultant is a work-at-home role. They will be required to travel and have reliable transportation to drive within the assigned geographic area (maximum of 60 miles) about 25-50% of the time.

The successful candidate will have a comprehensive knowledge of NCQA HEDIS and STARS Measures for both Medicare and Medicaid, with recent experience in the annual HEDIS audit. They will be comfortable accessing a variety of EMR systems remotely to obtain and abstract medical record data per specifications.

Responsibilities

Reviews documentation and abstracts compliant medical record data for entry into supplemental data tool.

Typical office working environment with productivity and quality expectations.

Professional customer service demeanor a plus as staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.

Commands a comprehensive knowledge of NCQA HEDIS and STARS Measures for both Medicare and Medicaid, with recent experience in the annual HEDIS audit.

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.

Requirements

Active and unrestricted Arizona or compact state RN license

Candidate must reside in the state of Arizona

Willing and able to drive within assigned geographic area (maximum of 60 miles) about 25-50% of the time and have reliable transportation

3+ years of clinical experience as a RN

Preferred Qualifications

Experience reading and interpreting medical records, including handwritten records

Experience documenting electronically using keyboard and multiple computer screens-- navigating through internal/external computer systems, and MS Office Suite applications, including Word and Excel

Education

Bachelors Degree in Nursing or higher required

Benefits

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 for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)