At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Must have: Active and unrestricted RN licensure in Illinois (IL) is a requirement. There is a preference for nurses in a compact RN licensure state, however, that is not required.
Schedule: Monday-Friday between the hours of 8:00am-5:00pm for a scheduled 8-hour shift. This is a fully remote role.Position Summary
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CVS Health Aetna has an opportunity for a full-time Quality Management Nurse Consultant. The Incident Reporting Quality Nurse Consultant plays a key role in ensuring timely, accurate, and compliant reporting of critical incidents across multiple Medicaid markets. This role primarily supports the Illinois Medicare-Medicaid Plan (MMP) but will assist other markets (OH, MI, NJ) as needed. The consultant performs clinical reviews, supports member and provider oversight, contributes to training efforts, and ensures alignment with Incident Reporting regulatory standards.Key Responsibilities
- Review and validate critical incidents for clinical accuracy, timeliness, and compliance.
- Monitor trends and escalate concerns related to late or misclassified incidents.
- Provide education to case managers on Incident Reporting processes and documentation.
- Collaborate with internal teams on corrective actions and audit preparation.
- Support Incident reporting tools, dashboards, and compliance tracking across markets.
- This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
- Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
- Active and unrestricted RN licensure in IL is required. Will be expected to obtain and maintain multi-state or state specific licensure.
- 3+ year(s) of experience in Nursing.
- 3+ year(s) of experience Care Management. (eg. linking members to resource, contacting appropriate external agency, understanding of the care management process.)
- 2+ year(s) of experience with documenting in an Electronic Medical Records (EMR).
- 3+ year(s) experience with Microsoft Excel, Outlook, PowerPoint and Teams.
- Experience with informal mentoring of staff.
- Compact RN License.
- Dynamo system experience.
- Associate of Applied Science in Nursing Required.
- BSN Preferred.
40Time Type
Full timePay Range
The typical pay range for this role is:$66,575.00 - $142,576.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and 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.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.