Remote RN: Clinical Claims Reviewer

CVS Health; North Dakota; A distancia; USD 40.000 - 86.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Descripción de la vacante

CVS Health is seeking a Clinical Claims Review Nurse to support remote, home-based work from North Dakota. The role requires an RN license with 2–3 years of experience and strong analytical skills to review medical claims against clinical criteria.

The position involves interpreting documentation, coordinating resolutions with clinicians, training staff, and ensuring compliance with laws and CVS workflows. It offers full-time hours with a competitive pay range and comprehensive benefits.

Formación

• Must be a licensed RN with 2–3 years of professional experience.
• Strong analytical skills to assess medical claims.
• Bachelor’s in Science & Nursing preferred.

Responsabilidades

• Review and interpret clinical documentation from medical records or systems.
• Apply 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 current team members.
• Identify trends and provide leadership feedback on discrepancies or potential fraud.
• Maintain compliance with applicable laws and internal workflows.

Conocimientos

RN license

Analytical skills

Clinical judgment

Healthcare claims review

Educación

Associate’s Degree in Nursing or Diploma RN

BSN preferred

Herramientas

Microsoft Office 365

EHR portal

VPN

Descripción del empleo

CVS Health is seeking a Clinical Claims Review Nurse to support remote, home-based work from North Dakota. The role requires an RN license with 2–3 years of experience and strong analytical skills to review medical claims against clinical criteria.

The position involves interpreting documentation, coordinating resolutions with clinicians, training staff, and ensuring compliance with laws and CVS workflows. It offers full-time hours with a competitive pay range and comprehensive benefits.