Remote Appeals Nurse Consultant (RN) | Clinical Resolution

CVS Health; Hartford (CT); Remote; USD 67,000 - 143,000; Full time

Job summary

CVS Health is seeking an Appeals Nurse Consultant to join our remote team. In this role, you will apply sound clinical judgment and regulatory knowledge to review and resolve clinical appeals in a fair and accurate manner.

The position requires an active RN license in the resident state, at least 3 years of clinical experience, and an associate's degree minimum. This is a full-time remote role with typical hours, plus occasional on-call coverage and a comprehensive benefits package.

Qualifications

• Active RN licensure in state of residence is required.
• Minimum 3 years of clinical experience.
• Preferred: Appeals, Managed Care, or Utilization Review experience.
• Proficiency with computers and navigating multiple systems.
• Exceptional communication and multitasking abilities.

Responsibilities

• Review and resolve clinical appeals.
• Review documentation and interpret data to apply criteria and policies per regulations.
• Coordinate clinical resolution with internal/external clinician support.
• Support UM, MPO, Coding, or Behavioral Health appeals.
• Full-time telework with standard hours 8:00 AM–5:00 PM (local time).
• Occasional weekend and holiday on-call coverage may be required.

Skills

Exceptional communication skills

Time management

Multitasking

Education

Associate's Degree

Job description

CVS Health is seeking an Appeals Nurse Consultant to join our remote team. In this role, you will apply sound clinical judgment and regulatory knowledge to review and resolve clinical appeals in a fair and accurate manner.

The position requires an active RN license in the resident state, at least 3 years of clinical experience, and an associate's degree minimum. This is a full-time remote role with typical hours, plus occasional on-call coverage and a comprehensive benefits package.