Clinical Claims Review Nurse

CVS Health; Alabama; Vor Ort; USD 36.000 - 77.000; Vollzeit

Benefits dieser Stelle

Bonus potential

Comprehensive benefits

Paid time off

Retirement savings options

Zusammenfassung

CVS Health is seeking a Clinical Claim Review Nurse in Alabama. You will review clinical data, apply policies to member and provider claims, and coordinate resolutions with clinicians. Strong analytical skills and RN licensure are required.

The role offers a base pay range with bonus eligibility and comprehensive benefits, reflecting CVS Health’s commitment to quality care and patient-centered service.

Qualifikationen

• RN license required and nursing degree.
• 2–3 years as an RN or equivalent clinical experience.
• Strong analytical skills to assess medical claims.

Aufgaben

• Review and interpret clinical data to apply clinical criteria and policies for member/provider claims.
• Coordinate clinical resolutions with clinicians/MDs as required.
• Review post-service claims for payment based on policies, legislation, and plan benefits.
• Navigate multiple systems and coordinate with internal departments or providers as needed.
• Apply confidentiality and comply with laws and company policies.

Kenntnisse

RN license

Analytical skills

Communication skills

Ausbildung

Associates Degree in Nursing

BSN preferred

Tools

Microsoft Office

Jobbeschreibung

CVS Health is seeking a Clinical Claim Review Nurse in Alabama. You will review clinical data, apply policies to member and provider claims, and coordinate resolutions with clinicians. Strong analytical skills and RN licensure are required.

The role offers a base pay range with bonus eligibility and comprehensive benefits, reflecting CVS Health’s commitment to quality care and patient-centered service.