Clinical Claims Review RN: Drive Accurate Compassionate Care

ISHE; Idaho; On-site; USD 36,000 - 95,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a qualified RN to review and interpret clinical documentation for post-service claims, applying criteria and policies to evaluate cases. The role involves coordinating resolutions with clinicians, training staff, and providing support to customer service and claims teams while staying compliant with laws.

This full-time position offers a comprehensive benefits package including medical, dental, vision, PTO, and retirement options, reflecting CVS Health's commitment to

Qualifications

• Active RN license in state of residence.
• RN degree and 2-3 years of professional RN experience.
• Strong analytical skills to assess medical claims.

Responsibilities

• Review and interpret clinical documentation from medical records.
• Apply clinical criteria and policies to post-service claims.
• Coordinate clinical resolutions with clinicians as required.
• Act as a resource for customer service and claims teams.
• Train new staff and provide cross-training to existing team members.
• Identify trends and report discrepancies or potential fraud.
• Ensure compliance with applicable laws and internal workflows.

Skills

Clinical judgment

Analytical skills

Attention to detail

Education

RN license

Bachelor's degree

Job description

CVS Health is seeking a qualified RN to review and interpret clinical documentation for post-service claims, applying criteria and policies to evaluate cases. The role involves coordinating resolutions with clinicians, training staff, and providing support to customer service and claims teams while staying compliant with laws.

This full-time position offers a comprehensive benefits package including medical, dental, vision, PTO, and retirement options, reflecting CVS Health's commitment to