Clinical Claims Review Nurse

CVS Health Corporation; North Dakota; Remoto; USD 36.000 - 94.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical coverage

Dental coverage

Vision coverage

Paid time off

Descrizione del lavoro

CVS Health is seeking a Clinical Claims Review Nurse to interpret clinical documentation and apply decision-making for post-service claims. This role supports claims processing teams and collaborates with clinicians to resolve complex cases.

The ideal candidate has RN licensure with 2–3 years of RN experience and may hold a bachelor’s degree. This full-time, remote position is based in North Dakota.

Competenze

• Nursing degree (RN) required.
• Bachelor’s degree preferred.
• 2–3 years of professional experience as a licensed RN or equivalent clinical experience.
• Current and unrestricted RN licensure in state of residence required.

Mansioni

• Review and interpret clinical documentation from medical records or systems.
• Apply clinical decision-making to utilize appropriate clinical criteria and policies for post-service claims.
• Coordinate clinical resolutions independently, with clinician/MD support as required.
• Act as a resource for customer service and claims processing teams.
• Train new staff and provide cross-training to existing team members.
• Identify trends and provide feedback to leadership if discrepancies or potential fraudulent activities are identified.
• Remain current with applicable laws, regulations, and internal workflows to ensure compliance.

Conoscenze

Analytical skills

Clinical nursing

Communication

Formazione

RN license

Bachelor’s degree preferred

Descrizione del lavoro

About This Role

The Clinical Claims Review Nurse at CVS Health is responsible for reviewing and interpreting clinical documentation, applying clinical decision-making for post-service claims, and coordinating clinical resolutions. This role is ideal for experienced nurses with strong analytical skills who are looking to contribute to a more connected and compassionate health experience.

Highlights

• Pay: $26.01 - $68.55/hour
• Location: Remote, ND
• Schedule: Full-time

What You'll Do

• Review and interpret clinical documentation from medical records or systems.
• Apply clinical decision-making to utilize appropriate clinical criteria and policies for post-service claims.
• Coordinate clinical resolutions independently, with clinician/MD support as required.
• Act as a resource for customer service and claims processing teams.
• Train new staff and provide cross-training to existing team members.
• Identify trends and provide feedback to leadership if discrepancies or potential fraudulent activities are identified.
• Remain current with applicable laws, regulations, and internal workflows to ensure compliance.

Requirements

Education

• Nursing degree (RN) required
• Bachelor’s degree preferred

Experience

• 2–3 years of professional experience as a licensed Registered Nurse (RN) or equivalent clinical experience

Licenses & Certifications

• Current and unrestricted Registered Nurse licensure in state of residence required

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources

About CVS Health

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They prioritize safety and quality in everything they do, fostering a workplace where every colleague feels valued and belongs.