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CVS Health

QM Nurse Consultant

Phoenix, AZ

Job Description
The QM Nurse Consultant is a work at home role. Candidates residing in AZ preferred, but open to those residing in other states.

• Experienced HEDIS record review nurse will be responsible for obtaining, reviewing, abstracting, and data entering medical records utilized for HEDIS ® supplemental data processes.

• Candidate must understand the NCQA HEDIS ® technical specifications for the designated HEDIS ® supplemental data measures, be able to apply understanding of the technical specifications in the process to review, abstract, and data enter supplemental data, collaborate with the health plan HEDIS ® project managers and other health plan departments (which may include but is not limited to member services, provider relations and integrated care management) to achieve the common goal of improving member outcomes, as measured by the HEDIS®/STAR measures.

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• If within the State of Arizona, may need to conduct onsite visits to obtain, review, abstract, and data enter all medical record data for large groups/groups that request an onsite visit.

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

• Typical office working environment with productivity and quality expectations.

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

The following skills and competencies required for the position:

• High level of accuracy and attention to detail
• The ideal candidate is self-motivated and comfortable working under tight deadlines.
• Conscientious problem solver, willing to learn, takes personal pride in their work performance/accuracy
• Proven organizational and time management skills required
• Professional customer service demeanor - as staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.
• 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.

Required Qualifications
• Active and unrestricted AZ or compact state RN license required

• 3+ years work related experience in the healthcare industry

• Experience reading and interpreting medical records, including handwritten records

• If within the State of Arizona, must have reliable transportation and be willing and able to drive within assigned geographic area (maximum of 60 miles) about 25-50% of the time once COVID restrictions are lifted.

COVID Requirements
CVS Health requires its Colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.

If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
• 1+ years experience with a variety of EMR systems highly preferred.

• 1+ years navigating multiple computer systems and keyboarding. Effective communication skills, both verbal and written

• 3+ years of Medical Record Review experience with HEDIS-specific measure reviewed.

BSN Required

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Job ID: CVS-1810682BR
Employment Type: Other

Perks and Benefits

  • Health and Wellness

    • Health Insurance
    • Dental Insurance
    • Vision Insurance
    • Life Insurance
    • HSA
    • HSA With Employer Contribution
    • Pet Insurance
    • Mental Health Benefits
  • Parental Benefits

    • Fertility Benefits
    • Adoption Assistance Program
    • Family Support Resources
  • Work Flexibility

    • Flexible Work Hours
    • Remote Work Opportunities
    • Hybrid Work Opportunities
  • Vacation and Time Off

    • Paid Vacation
    • Paid Holidays
    • Personal/Sick Days
  • Financial and Retirement

    • 401(K) With Company Matching
  • Professional Development

    • Tuition Reimbursement
  • Diversity and Inclusion

    • Employee Resource Groups (ERG)
    • Diversity, Equity, and Inclusion Program