Appeals Nurse Consultant (Remote)

CVS Health; Charleston (WV); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Job summary

CVS Health invites applications for a remote Appeals Nurse Consultant. You will review and resolve clinical appeals using sound clinical judgment and regulatory knowledge, coordinating with clinicians as required.

The role is full-time, with standard hours Monday through Friday 8:00 AM–5:00 PM local time and occasional on-call coverage on weekends or holidays. Active RN licensure in state of residence and at least 3 years of clinical experience are required.

Qualifications

• Must have active and unrestricted RN licensure in state of residence.
• 3+ years clinical experience.
• Experience in appeals, managed care or utilization review is preferred.
• Proficiency with computer skills including navigating multiple systems.
• Exceptional communication skills and strong time-management abilities.

Responsibilities

• Review and resolve clinical appeals.
• Interpret data from clinical records applying appropriate criteria and policies in line with regulatory requirements.
• Coordinate clinical resolution with internal/external clinician support as required.
• Support UM (including expedited), MPO, Coding, or Behavioral Health appeals as needed.
• Full-time remote role with standard hours Mon-Fri 8:00 AM–5:00 PM local time; occasional weekend/holiday on-call may be required.

Skills

RN licensure

Clinical experience

Appeals experience

Managed Care

Utilization Review

Computer skills

Communication skills

Multitasking

Education

Associate's Degree

Tools

Health IT systems

Job description

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.

Position Summary

CVS Aetna is seeking a dedicated Appeals Nurse Consultant to join our remote team. In this role, you will play a critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical judgment and regulatory knowledge.

Key Responsibilities

• Responsible for the review and resolution of clinical appeals.
• Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues.
• Independently coordinates the clinical resolution with internal/external clinician support as required.
• This position may support UM (includes expedited), MPO, Coding, or Behavioral Health appeals.
• This is a full-time telework position with standard hours of Monday–Friday, 8:00 AM to 5:00 PM (local time).
• Occasional weekend and holiday on-call coverage may be required.

Remote Work Expectations

• This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

Required Qualifications

• Must have active and unrestricted RN licensure in state of residence.
• 3+ years clinical experience.

Preferred Qualifications

• Appeals, Managed Care, or Utilization Review experience.
• Proficiency with computer skills including navigating multiple systems.
• Exceptional communication skills.
• Time efficient, highly organized, and ability to multitask.

Education

• Associate's Degree minimum.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$54,095.00 - $116,760.00

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: 11/13/2026

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