Experienced QM Nurse Consultant for Aetna Remot...

Join CVS Health and Make a Difference in Healthcare At CVS Health, we're driven by a singular purpose: bringing our heart to every moment of your health. Our mission is to deliver improved, human-driven healthcare for a rapidly changing world. As a valued member of our team, you'll be empowered to play a vital role in transforming our culture and accelerating our ability to grow and deliver solutions that make healthcare more personal, convenient, and affordable. About the Role: QM Nurse Consultant We're seeking an experienced QM Nurse Consultant to join our team on a full-time, remote basis. As a QM Nurse Consultant, you'll play a critical role in reviewing, abstracting, and data entering clinical records for HEDIS supplemental data processes. This is an exciting opportunity to work with a dynamic team and make a meaningful contribution to improving member outcomes, as measured by HEDIS/STAR measures. Key Responsibilities: Review, abstract, and data enter clinical records for HEDIS supplemental data processes, utilizing various EMR systems. Apply knowledge of NCQA HEDIS technical specifications to survey, abstract, and data enter supplemental data. Collaborate with health plan HEDIS project directors and other health plan departments to achieve shared goals. Conduct local visits to acquire, review, abstract, and data enter clinical record data for large groups/clusters, as required (for Arizona-based candidates). Survey documentation and abstract consistent clinical record data for entry into supplemental data tools. Maintain a professional client support demeanor, contacting providers of record, vendors, or internal Aetna departments to obtain additional information, as needed. Utilize various electronic tools, including Microsoft Word, Adobe Acrobat, and Windows 10. Demonstrate a high degree of accuracy and attention to detail, meeting productivity and quality expectations. Essential Qualifications: Current and unlimited Arizona or compact state RN license. 3+ years of clinical experience. 3+ years of experience reading and interpreting clinical records, including handwritten records. 3+ years of experience recording electronically using keyboard and various PC screens, navigating through internal/external PC systems, and MS Office Suite applications, including Word and Excel. Strong analytical and problem-solving skills. Excellent verbal communication skills, with the ability to convey clear, concise, and relevant information. Proficient in PC skills, including navigating different systems and keyboarding. Preferred Qualifications: Clinical Record Review and HEDIS Experience. Experience with various EMR systems. PC proficiency and demonstrated ability to navigate through internal/external PC systems, Adobe, and MS Office Suite applications. What We Offer: As a CVS Health team member, you'll enjoy a comprehensive benefits package, including competitive compensation ($25-$40/hour), opportunities for career growth and development, and a dynamic work environment that fosters collaboration and innovation. Our remote work arrangement allows you to work from anywhere in the U.S., with the flexibility to manage your work-life balance. Career Growth and Development: At CVS Health, we're committed to helping our team members grow and develop in their careers. As a QM Nurse Consultant, you'll have opportunities to: Develop your skills and expertise in HEDIS and clinical record review. Collaborate with cross-functional teams to drive business outcomes. Participate in training and development programs to enhance your knowledge and skills. Our Culture: At CVS Health, we're passionate about creating a culture that is inclusive, diverse, and supportive. Our Heart At Work Behaviors guide our interactions with each other and with our customers, ensuring that we're delivering care that's personal, convenient, and affordable. Why Join Us? If you're a motivated and detail-oriented professional looking for a challenging and rewarding opportunity, we want to hear from you. As a QM Nurse Consultant, you'll play a critical role in driving business outcomes and improving member outcomes. Join our team and make a meaningful contribution to the healthcare industry. Ready to Apply? If you believe you have what it takes to excel in this role, submit your application today. We're excited to hear from talented candidates like you! Equal Employment Opportunity: CVS Health is an equal employment opportunity employer, committed to diversity and inclusion in the workplace. Apply for this job