QM Nurse Consultant

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

Applies specialized clinical knowledge to participate in quality improvement efforts to assess and enhance patient care. Collaborates with the healthcare quality team to collect and analyze clinical data, participate in quality reviews, and identify opportunities for process improvement. Provides insights and recommendations to optimize healthcare practices and promote patient safety and satisfaction.

The QM Nurse Consultant (Nurse Navigator) role strengthens WV Medicaid’s ability to improve member outcomes through clinically guided, member‑centric quality interventions. This role brings licensed nursing expertise to quality management activities, with a primary focus on identifying member needs, supporting care gap closure, and collaborating with interdisciplinary teams to address barriers to care.

The QM Nurse Consultant applies clinical judgement to guide quality initiatives, prioritize member engagement, and support adherence to evidence-based care.

Required Qualifications

Prior Relevant Work Experience 3-5 years

Active Registered Nurse (RN) required

Preferred Qualifications

Certified Professional in Healthcare Quality (CPHQ) preferred

Experience with clinical or quality improvement and process improvement

Manage care experience preferred

Experience working with the Medicaid population

Education

Bachelor's degree preferred/specialized training/relevant professional qualification

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.