Remote Appeals Nurse Consultant - Clinical Resolution

CVS Health; United States; Remote; USD 54.000 - 117.000; Vollzeit

Benefits dieser Stelle

Medical, dental, and vision coverage

Zusammenfassung

CVS Health is seeking a dedicated Appeals Nurse Consultant to join our remote team. You will apply sound clinical judgment and regulatory knowledge to ensure fair resolution of clinical appeals. This full-time, 100% remote position features standard hours and occasional on-call coverage.

Responsibilities include reviewing documentation, interpreting data from records, and coordinating with internal/external clinicians. Prior appeals or utilization review experience is preferred.

Qualifikationen

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

Aufgaben

• Review and resolve clinical appeals.
• Interpret data from clinical records to apply criteria and policies per regulatory requirements.
• Coordinate clinical resolution with internal/external clinician support.
• Support UM (including expedited), MPO, Coding, or Behavioral Health appeals as needed.
• Work full-time remotely with standard hours, Mon-Fri 8:00 AM–5:00 PM (local time).
• Occasional weekend and holiday on-call coverage may be required.

Kenntnisse

Nursing

Communication

Multitasking

Ausbildung

Associate's Degree

Tools

Jobbeschreibung

CVS Health is seeking a dedicated Appeals Nurse Consultant to join our remote team. You will apply sound clinical judgment and regulatory knowledge to ensure fair resolution of clinical appeals. This full-time, 100% remote position features standard hours and occasional on-call coverage.

Responsibilities include reviewing documentation, interpreting data from records, and coordinating with internal/external clinicians. Prior appeals or utilization review experience is preferred.