Clinical Claims Review Nurse

CVS Health; Bismarck (ND); Vor Ort; USD 36.000 - 77.000; Vollzeit

Benefits dieser Stelle

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Zusammenfassung

CVS Health is seeking a Clinical Claim Review Nurse to evaluate clinical data and determine eligibility for post-service claims. The role requires RN licensure and 2–3 years of professional nursing experience.

The candidate will apply clinical criteria and collaborate with clinicians to resolve complex cases. Responsibilities include reviewing medical records, interpreting data, and ensuring compliance with state and federal laws.

Qualifikationen

• RN licensure is required.
• 2–3 years of professional nursing experience as an RN or equivalent clinical experience.
• Strong analytical skills to assess medical claims and documentation.

Aufgaben

• Review and evaluate clinical information and documentation for post-service claims.
• Apply clinical decision-making to determine appropriate criteria and policies.
• Coordinate clinical resolutions with clinicians/MDs when needed.

Kenntnisse

RN licensure

Analytical skills

Clinical decision making

Ausbildung

Associates Degree in Nursing

BSN preferred

Tools

Microsoft Suite

Jobbeschreibung

CVS Health is seeking a Clinical Claim Review Nurse to evaluate clinical data and determine eligibility for post-service claims. The role requires RN licensure and 2–3 years of professional nursing experience.

The candidate will apply clinical criteria and collaborate with clinicians to resolve complex cases. Responsibilities include reviewing medical records, interpreting data, and ensuring compliance with state and federal laws.