Appeals Nurse Clinician — Behavioral Health Expert

CVS Health; Frankfort (KY); Presencial; USD 54.000 - 117.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Descripción de la vacante

CVS Health is seeking a licensed RN to lead intake, investigation and resolution of appeals, complaints and grievances across products. You will interpret clinical records, apply criteria, coordinate with clinicians and internal teams, and report trends to improve outcomes.

A strong emphasis is on behavioral health experience and regulatory compliance. This full-time role offers a comprehensive benefits package and opportunities to impact patient care within CVS Health's expansive health

Formación

• Experience reading or researching benefit language.
• Excellent verbal and written communication skills.
• Excellent customer service skills.
• 3-5 years of clinical experience required.
• Behavioral health experience is required (3-5 years).

Responsabilidades

• Handle intake, investigation and resolution of appeals, complaints and grievances.
• Coordinate responses from multiple business units and clinicians as needed.
• Review clinical documentation and apply criteria in line with regulatory requirements.
• Coordinate with members, providers, and internal/external teams; report findings to leadership.
• Identify trends and suggest improvements to the appeals process.
• Ensure timely, patient-centered responses and regulatory compliance.

Conocimientos

Clinical experience

Verbal communication

Written communication

Customer service

Educación

RN with current unrestricted state licensure

Descripción del empleo

CVS Health is seeking a licensed RN to lead intake, investigation and resolution of appeals, complaints and grievances across products. You will interpret clinical records, apply criteria, coordinate with clinicians and internal teams, and report trends to improve outcomes.

A strong emphasis is on behavioral health experience and regulatory compliance. This full-time role offers a comprehensive benefits package and opportunities to impact patient care within CVS Health's expansive health