Remote QM Nurse Consultant, OH

CVS Health

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OH – Work from home
Full time
Posted Today

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.




Position Summary:


This is a remote position.


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:

Critical Incident and Potential Quality of Care monitoring, collaboration and coordination with plan HEDIS teams on OhioRISE specific measure reporting, education, and monitoring; risk score and persistency data monitoring; development of 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.

Required Qualifications

  • Active and unrestricted RN Ohio state licensure required.
  • 3+ years of clinical experience required.
  • 1+ year(s) using computer on internal and external programs, data entry and MS office experience required.
  • Must reside in Ohio.

Preferred Qualifications

  • 1+ year(s) behavioral health, social work or public health experience preferred.
  • 1+ year(s) HEDIS and chart reviewing experience preferred.
  • 1+ year(s) Managed Care experience preferred.



  • Associate’s degree required.
  • Bachelor’s degree preferred.



Pay Range

The typical pay range for this role is:


$60,522.80 – $129,600.00


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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  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.