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

The Healthcare Quality Management Auditor participates in the development and ongoing implementation of QM (quality management) Work Plan activities. This person will improve quality products and services by using measurement and analysis to process, evaluate, and make recommendations to meet QM objectives.

Job duties include (but are not limited to)

• Completes a variety of onsite medical and clinical audits for all lines of business, including AHCCCS (Arizona Health Care Cost Containment System), DES (Department of Economic Security) and DCS-CHP (Department of Child Safety - Comprehensive Health Plan).
• Conducts exit interviews with clinical and leadership staff to review audit results.
• Assists with developing corrective action plans.
• Develops audit tools for all populations.
• Tracks completion of corrective action plans.
• Completes data entry on all audit tools.
• Participates in completing inter rater reliability and scoring guidelines.
• Participates in QM meetings.

Required Qualifications

• Active RN (Registered Nurse) or LPN (Licensed Practical Nurse) license, valid in the state of Arizona.
• 1+ year of experience in behavioral health and/or long-term care.
• Must reside in Arizona.
• Ability to travel in Arizona up to 80% of the time.
• Demonstrated proficiency in Microsoft Office Suite, primarily Excel.

Preferred Qualifications

• Previous experience working in a provider setting.
• Previous experience with medical record QM auditing and/or case management.
• Strong attention to detail.
• Ability to learn quickly and remain adaptable amidst an evolving environment.
• Strong relationship building skills.
• Previous experience in an outpatient behavioral health environment.
• Previous experience working with medical records and/or Electronic Health Records (EHR).

Education

• Bachelor's degree or equivalent experience (4 years of relevant experience + high school diploma or GED).

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $85,068.00

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, 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: 12/03/2025

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