QM Nurse Consultant
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Idaho • Pennsylvania • United States
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Salary
💰 $54,095 - $155,538 per year
About the role
- Responsible for the review and evaluation of clinical information and documentation
- Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with clinical editing, policy and coding standards
- Evaluates documentation/information to determine compliance with clinical policy, regulatory, and accreditation guidelines
- Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand
- Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated
Requirements
- 3-5 years of direct care clinical experience as an RN required
- Active and unrestricted RN licensure required in candidate's state of residence
- 2 years’ experience with MS Office suite applications including Excel
- Strong computer skills utilizing multiple systems and applications at the same time
- Must have critical thinking skills
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical evaluationclinical documentation reviewdata interpretationcompliance assessmentclinical policy applicationregulatory guidelinesaccreditation standardscritical thinking
Soft Skills
attention to detailcommunicationproblem-solving
Certifications
RN licensure