Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Gathers data, reviews and evaluates clinical information from multiple system applications and internal sources to assess for potential quality of care issues, barriers and opportunities for improvement. Analyzes and condenses complex information into clear and precise reports and presentations for internal and external use. Conducts medical record review and audits and reports findings to appropriate parties. Pro-actively and consistently applies regulatory and accreditation standards to assure activities are processed within guidelines. Staff will be required to collaborate with providers, vendors, and internal Aetna departments for data gathering and reporting outcomes.

Required Qualifications

Must reside in PennsylvaniaActive and unrestricted Registered Nurse in PA3+ years of clinical experience1+ year of quality management experience1+ year(s) of experience with Microsoft Office applications (Outlook, Teams, Excel, PowerPoint)Willing and able to travel throughout Pennsylvania occasionally on a quarterly basis to provider offices/community locationsWorking schedule: Monday - Friday 8:00am-5:00pm EST

Preferred Qualifications

CPHQ CertificationKnowledge of NCQA AccreditationManaged Care experienceProject management experienceExperience delivering presentations to providers, committees, or stakeholdersStrong critical thinking skills

Education

Diploma RN or Associates in Nursing requiredBSN preferred

Anticipated Weekly Hours

40

Time Type

Full 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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 03/31/2025

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