Quality Management, Nurse Consultant

CVS Health; Columbus (OH); Remote; USD 54,000 - 117,000; Full time

Job summary

A leading health solutions company is seeking a Quality Management Nurse Consultant to oversee behavioral health services for children in Ohio. The ideal candidate will be a Registered Nurse with clinical experience, familiarity with the Ohio healthcare system, and an understanding of NCQA Accreditation. This position offers remote work and a competitive salary ranging from $54,095 to $116,760, reflecting the importance of care coordination in a compassionate environment.

Benefits

Affordable medical plan options

401(k) plan with company matching

Flexible work schedules

Qualifications

• 3 years of clinical experience required.
• 1 year experience with NCQA Accreditation.
• Familiar with Ohio system of care.

Responsibilities

• Monitor quality of care and critical incidents.
• Collaborate with plan HEDIS teams.
• Develop quality strategy for medically complex population.

Skills

Registered Nurse (RN)

Clinical experience

Computer skills

Familiarity with Ohio system of care

Experience with NCQA Accreditation

Education

Associate's degree in Nursing

Tools

Microsoft Office

Job description

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

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.

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 year experience with NCQA Accreditation

Preferred Qualifications

• 1 year behavioral health, social work or public health experience preferred.
• 1 year Managed Care experience preferred.
• 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:

$54,095.00 - $116,760.00

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.

Benefits

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an 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 and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 10/10/2025

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.