We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
This role has a strong compliance, quality, and operational focus, so the posting should emphasize impact, cross-functional collaboration, and the opportunity to drive quality outcomes.
Clinical Quality & Compliance RN
Remote | RN Required
Are you a detail-oriented RN with a passion for quality, compliance, and operational excellence? Join our team and play a key role in ensuring utilization management processes meet regulatory, accreditation, and quality standards that support exceptional member care.
What You'll Do
- Lead and support audit, accreditation, and regulatory submission activities across utilization management operations.
- Coordinate and monitor ongoing operational oversight activities, ensuring timely completion of critical deliverables.
- Support NCQA accreditation, compliance audits, Medicare and state regulatory submissions, and other quality initiatives.
- Analyze compliance trends and denial letter quality findings to identify improvement opportunities and strengthen operational performance.
- Partner with teams across operations, compliance, accreditation, and governance to drive accountability and process excellence.
- Maintain audit documentation, reporting, corrective action tracking, and compliance records.
- Help ensure operational processes align with regulatory requirements, accreditation standards, and organizational policies.
What You'll Bring - REQUIRED
- Active, unrestricted RN license in the state of residence.
- 5+ years of experience in healthcare operations, utilization management, clinical quality, compliance, accreditation, audit support, or related areas.
- Experience supporting audits, regulatory submissions, accreditation reviews, or compliance monitoring activities.
- Strong project coordination, organizational, and problem-solving skills.
- Excellent communication skills and ability to collaborate across cross-functional teams.
- Commitment to accuracy, accountability, and continuous improvement.
- Experience with Medicare, Medicaid, managed care, or utilization management operations.
- Associate Degree in Nursing.
Preferred Qualifications
- Experience with NCQA accreditation.
- Knowledge of denial letter compliance and quality review processes.
- Experience working with accreditation, audit, governance, or compliance stakeholders.
- BSN preferred.
Why Join Us?
In this highly visible role, you'll help strengthen operational quality, improve compliance performance, and support safe, high-quality care for members through disciplined execution, collaboration, and continuous improvement.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$60,522.00 - $129,615.00This 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Active, unrestricted RN license in state of residence.
- 5+ years experience in healthcare operations, utilization management, clinical quality, compliance, accreditation, audit support, or related areas.
- Experience supporting audits, regulatory submissions, accreditation reviews, or compliance monitoring.
- Strong project coordination, organizational, and problem-solving skills.
- Excellent communication skills and ability to collaborate across cross-functional teams.
- Commitment to accuracy, accountability, and continuous improvement.
- Experience with Medicare, Medicaid, managed care, or utilization management operations.
- Associate Degree in Nursing.
- Experience with NCQA accreditation.
- Knowledge of denial letter compliance and quality review processes.
- Experience working with accreditation, audit, governance, or compliance stakeholders.
- Bachelor of Science in Nursing (BSN).
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
-
Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
-
Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
-
Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
