Full Job Description
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
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$54,095.00 - $142,576.00
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.
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.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 06/29/2026
