Remote Appeals Nurse Consultant – Fair Care Decisions

CVS Health; Connecticut; Remote; USD 67,000 - 143,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement options

Job summary

CVS Health is seeking an Appeals Nurse Consultant to join our remote team. In this role you will review clinical appeals, apply clinical criteria, and ensure fair, compliant resolutions for members and providers.

The position is fully remote with standard hours and requires an active RN license and at least three years of clinical experience. You will collaborate with internal and external clinicians, may support utilization management and related areas, and participate in occasional on-call

Qualifications

• RN licensure active and unrestricted in the state of residence.
• Minimum 3 years of clinical experience.
• Preferred: Appeals, Managed Care, or Utilization Review.
• Proficient with computer systems and multiple software platforms.
• Excellent communication, organization, and multitasking abilities.

Responsibilities

• Review and resolve clinical appeals per regulatory and policy requirements.
• Interpret data from clinical records to apply appropriate criteria and policies.
• Coordinate clinical resolutions with internal/external clinician support.
• Support UM, MPO, Coding, or Behavioral Health appeals as needed.
• This is a full-time remote role with standard hours, occasional on-call coverage.

Skills

Communication

Multitasking

Time management

Organization

Education

Associate's Degree

Tools

Computer systems proficiency

Job description

CVS Health is seeking an Appeals Nurse Consultant to join our remote team. In this role you will review clinical appeals, apply clinical criteria, and ensure fair, compliant resolutions for members and providers.

The position is fully remote with standard hours and requires an active RN license and at least three years of clinical experience. You will collaborate with internal and external clinicians, may support utilization management and related areas, and participate in occasional on-call