- R0876039
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
This is a work from home position with up to 10% travel
As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.
For the OhioRISE Program, the Quality Management Nurse Consultant position is responsible for the following job functions such as:
Potential Quality of Care monitoring, critical incident reporting, collaboration and coordination with plan HEDIS teams on OhioRISE specific measure reporting, education, and monitoring; developing quality strategy and framework for medically complex population; monitoring and tracking of OhioRISE Program performance measures; data collection and monitoring of Trauma Informed Care, Adverse Childhood Events, and other required training outcomes; participation in implementation of OhioRISE specific performance improvement projects; and assistance with OhioRISE related NCQA deliverables including review and evaluation of clinical information and documentation.
Develops, updates, and maintains Incident Management System (IMS) training to ensure staff and stakeholders understand incident definitions, reporting expectations, timelines, roles and responsibilities, documentation standards, and prevention planning requirements. Translates regulatory and internal process requirements into clear, accessible learning experiences and practical tools (e.g., facilitator materials, job aids, and knowledge checks), using scenario-based content to reinforce accurate incident identification, health and safety documentation, and high-quality prevention planning.
Enter data into the Incident Management System (IMS) and work in partnership with Psychiatric Residential Treatment Facilities, Care Management Entities, and the Ohio Department of Medicaid to respond to inquiries and deliver comprehensive information regarding critical incidents.
Required Qualifications
– Registered Nurse (RN) with current unrestricted state licensure required.
– 3 years of clinical experience required.
– 1 year using computer on internal and external programs, data entry and Microsoft office experience required.
– Familiar with Ohio system of care
– 1 years experience with NCQA Accreditation
Preferred Qualifications
– 1 year behavioral health, social work or public health experience preferred.
– 1 year Managed Care experience preferred.
– 1 year HEDIS experience, PQOC, and Critical Incidents
– Bachelor’s Of Science in Nursing
Education
Associate’s degree in Nursing
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$60,522.00 – $129,615.00
This 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 people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 04/28/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
