Health Care QM Consultant

Job DescriptionThe Healthcare Quality Management Consultant is a full time telework position. This position participates in the development and ongoing implementation of QM Work Plan activities. Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives.At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. We’re a local company, serving Arizonans of all ages who are eligible for Medicaid since 1985. We also serve people who are eligible for both Medicaid and Medicare. In April 2021 we’re going to begin delivering integrated physical and behavioral health services to children involved with the child welfare system, in a unique partnership with the Arizona Department of Child Safety and their Comprehensive Health Plan. We value diversity, compassion, innovation, collaboration and advocacy. If your values are the same as ours, let’s work together to make a difference and improve the health and wellbeing of Arizona. Fundamental Components:- Processes and evaluates complex data and information sets (e.g. accreditation/regulatory standards, HEDIS data, Geoaccess data).- Performs quantitative and qualitative data analysis.- Converts the results of data analysis into meaningful business information and reaches conclusions about the data.- Prepares and completes QM documents based on interpretation and application of business requirements.- Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements.- Assists in the development and implementation of QM projects and activities.- Accountable for completing and implementation of QM Work Plan Activities (e.g. QM committees, audits, clinical reviews,).- Prepares and reports business information to internal and external constituents and consults with constituents on solutions to business issues (e.g. delegates, committees, workgroups, regulators).- Evaluates and makes recommendations for corrective actions regarding credentialing events and potential quality concerns. May require clinical knowledge.- Responsible for the ongoing maintenance and implementation of quality improvement projects and initiatives.Required QualificationsBachelor's degree, Nursing degree, or other comparable healthcare experience.- 3 years’ work-related experience in the healthcare industry.- 3 plus years' clinical and/or managed care experience in the healthcare industry or quality management.- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.- Must be Arizona based.- This position requires the ability to travel statewide with a personal vehicle up to 25% of the time. Qualified candidates must have a valid AZ driver's license, reliable transportation, and proof of vehicle insurance.

Preferred QualificationsN/AEducationBachelor's degree

Business OverviewAt Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.