Appeals Nurse Consultant - Remote Position

Lensa; Phoenix (AZ); Remote; USD 54,000 - 143,000; Full time

Job summary

A leading company is seeking an Appeals Nurse Consultant for a remote position. The role involves processing Medicare appeals, requiring strong clinical experience and an active RN license. Ideal candidates will have managed care and utilization management experience, contributing to a team dedicated to transforming healthcare.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness programs

Tuition assistance

Qualifications

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

Responsibilities

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

Skills

Clinical experience

Independent work

Team collaboration

Education

Associates Degree

Bachelors Degree

Job description

Appeals Nurse Consultant - Remote Position

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 will be working from home anywhere in the US.

Standard business hours 8a-5p in time zone of residence Monday - Friday.

Position Summary

The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare appeals for participating providers. Primary duties may include, but are not limited to: Requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast-paced department. Must work independently as well as in a team environment while working remotely. Fast paced sedentary position, talking on the telephone, looking at computer screens, utilizing templates in Word, and typing on the computer.

Required Qualifications

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

Preferred Qualifications

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

Education

• Associates Degree minimum required
• Bachelors Degree preferred
  
  

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$54,095.00 - $142,576.00

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: 06/04/2025

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

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