Appeals Nurse Consultant - Remote Position

Lensa; Jefferson City (MO); Remote; USD 54,000 - 143,000; Full time

Job summary

A leading health solutions company is seeking an Appeals Nurse Consultant for a remote position. The role involves processing Medicare appeals, requiring clinical expertise and RN licensure. Applicants should have strong analytical skills and the ability to work independently in a fast-paced environment. Comprehensive benefits and a competitive salary range are offered.

Benefits

Medical plans

401(k) with matching

Tuition assistance

Paid time off

Flexible schedules

Qualifications

• 3+ years of clinical experience required.
• Active RN licensure in the state of residence.
• Experience in Managed Care and Utilization Management preferred.

Responsibilities

• Process medical necessity of Medicare appeals.
• Request clinical research and apply Medicare Guidelines.
• Navigate multiple computer systems in a fast-paced environment.

Skills

Clinical experience

Communication

Analytical skills

Education

Associates Degree

Bachelor’s Degree

Job description

Appeals Nurse Consultant - Remote Position

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Lensa is the leading career site for job seekers at every stage of their career. Our client, CVS Health, is seeking professionals. Apply via Lensa today!

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.

This position is remote, working from anywhere in the US.

Standard business hours are 8 a.m. to 5 p.m., in the time zone of residence, Monday through Friday.

Position Summary

The Appeals Nurse Consultant is responsible for processing the medical necessity of Medicare appeals for participating providers. Key duties include requesting clinical research, extrapolating pertinent clinical information, applying Medicare Guidelines, navigating multiple computer systems in a fast-paced environment, and working independently or as part of a team remotely. The role involves sedentary work, talking on the phone, viewing screens, using Word templates, and typing.

Required Qualifications

• 3+ years of clinical experience
• Active and unrestricted RN licensure in the state of residence

Preferred Qualifications

• Managed Care experience
• Utilization Management experience
• Appeals experience
• Pre-Certification and Pre-Authorization experience

Education

• Associates Degree minimum required
• Bachelor’s Degree preferred

Work Details

Anticipated weekly hours: 40

Employment type: Full-time

Pay Range

The typical pay range for this role is $54,095.00 - $142,576.00. The actual salary depends on experience, education, location, and other factors. This role may also include bonuses or incentives.

Benefits

We offer comprehensive benefits including medical plans, 401(k) with matching, stock purchase plans, wellness programs, paid time off, flexible schedules, family leave, dependent care resources, tuition assistance, and more. For details, visit CVS Benefits.

Application deadline: 06/04/2025. Qualified applicants with criminal records will be considered according to law. We are an equal opportunity employer, committed to diversity and inclusion.

Additional Information

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Healthcare Provider
• Industries: IT Services and IT Consulting