Quality Management Nurse Consultant (Remote-Arizona)

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. Schedule:Monday–Friday, 8:00 AM–5:00 PM Location:Arizona, Phoenix Metro Area Travel:Up to 10% local travel required (mileage reimbursed per company policy) Position Summary Join a mission-driven organization that’s making a real difference in the lives of Arizonans. Mercy Care, a not-for-profit Medicaid managed care health plan administered by Aetna, a CVS Health company, is seeking a Quality Management Nurse Consultant to help ensure the highest standards of care for our diverse member population. In this remote role, you’ll be part of a collaborative, experienced, and supportive nursing team that values learning, growth, and professional excellence. Every day brings something new; our cases are varied and complex, offering you the opportunity to expand your clinical knowledge across multiple specialties and populations. You’ll work in a positive, stable environment with leadership that’s deeply experienced and committed to your success. With the backing of a national organization and the heart of a local team, you’ll help shape the quality of care for families, children, seniors, and individuals with developmental and cognitive disabilities across Arizona. If you're passionate about clinical quality, thrive in a dynamic setting, and want to be part of a team that truly puts members first, this is the role for you! Key Responsibilities • Responsible for the review and evaluation of clinical information and documentation related to potential quality of care concerns. • Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. • Independently coordinates the clinical resolution with internal/external clinician support as required. • Requires some travel to provider locations as needed. Remote Work Expectations • This is a remote role; candidates must have a dedicated workspace free of interruptions. • Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required Qualifications • Active and unrestricted Arizona RN license. • Must reside in Arizona. • Minimum 1 year nursing experience required. • Must have reliable transportation and willing and able to participate in local travel up to 10% of the time. Mileage will be reimbursed per company policy. Preferred Qualifications • Experience in managed care or health plan setting. • Computer literacy and proficiency with navigating through internal/external computer systems, electronic medical record systems, and MS Office Suite applications, including Word and Excel. • Strong analytical and communication skills. Education • Associate's degree in nursing required. • Bachelor's degree in nursing preferred. Anticipated Weekly Hours40 Time TypeFull 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 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,a401(k) plan(including matching company contributions), and anemployee stock purchase plan. • No-cost programs for all colleaguesincluding wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleaguesincluding 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: 08/11/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.