Appeals Nurse Consultant - Remote Position

Lensa; Salem (OR); Remote; USD 54,000 - 143,000; Full time

Job summary

A leading career site is seeking an Appeals Nurse Consultant for a remote position with CVS Health. The role involves processing Medicare appeals, requiring clinical expertise and RN licensure. Comprehensive benefits and a supportive work environment are offered, with a focus on diversity and equal opportunity.

Benefits

Comprehensive medical plans

401(k) plan

Stock purchase plans

Wellness programs

Flexible schedules

Qualifications

• 3+ years of clinical experience required.
• Active RN licensure in the state of residence.

Responsibilities

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

Skills

Clinical experience

Independent work

Team collaboration

Education

Associates Degree

Bachelor's Degree

Job description

Appeals Nurse Consultant - Remote Position

15 hours ago Be among the first 25 applicants

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 the 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 include requesting clinical research, extrapolating pertinent clinical data, applying Medicare Guidelines, navigating through multiple computer systems in a fast-paced environment. Must work independently and as part of a team while working remotely. The position involves a sedentary activity, including talking on the phone, looking at computer screens, utilizing 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

Additional Details

Anticipated weekly hours: 40

Employment type: Full-time

Pay range: $54,095 - $142,576 annually, depending on experience and other factors. This role may be eligible for bonuses or incentives.

We offer comprehensive benefits including medical plans, 401(k), stock purchase plans, wellness programs, flexible schedules, and more. For details, visit CVS Benefits.

Application deadline: 06/04/2025

We are committed to diversity and equal opportunity employment.

Additional Information

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Healthcare Provider