Remote RN: Clinical Claims Reviewer & Quality Advocate

CVS Health; Kansas; Hybrid; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a licensed RN to review and interpret clinical documentation, applying policy-driven criteria to post-service claims while coordinating with clinicians as needed. The role supports customer service and claims teams, with opportunities to train staff and identify trends.

The position emphasizes HIPAA compliance and requires a quiet, dedicated home workspace, strong technical literacy, and the ability to work remotely within the employee's state of residence.

Qualifications

• RN license required.
• Minimum 2–3 years of professional RN experience.
• Strong analytical skills to assess medical claims.

Responsibilities

• Review and interpret clinical documentation from medical records or systems.
• Apply clinical decision-making to use appropriate criteria and policies for post-service claims with clinician support as needed.
• Act as a resource for customer service and claims processing teams.

Skills

Analytical skills

Education

Nursing degree (RN)

Tools

Microsoft Office 365

Job description

CVS Health is seeking a licensed RN to review and interpret clinical documentation, applying policy-driven criteria to post-service claims while coordinating with clinicians as needed. The role supports customer service and claims teams, with opportunities to train staff and identify trends.

The position emphasizes HIPAA compliance and requires a quiet, dedicated home workspace, strong technical literacy, and the ability to work remotely within the employee's state of residence.