RN Appeals Nurse Consultant — Behavioral Health

CVS Health; Central City (KY); Sur place; USD 54 000 - 117 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Bonus opportunity

Résumé du poste

CVS Health is seeking an RN with an unrestricted license to manage appeals, complaints and grievances for all products. The role requires 3-5 years of Behavioral Health experience and familiarity with managed care. This is a full-time position based in Kentucky.

You will review clinical documentation, coordinate with clinicians, and ensure regulatory compliance while delivering timely, customer-focused resolutions. CVS Health offers comprehensive benefits and a supportive work environment.

Qualifications

• RN with current unrestricted state licensure.
• 3-5 years of Behavioral Health experience.
• Excellent customer service skills.
• Data gathering via multiple system applications.

Responsabilités

• Handle intake, investigation and resolution of appeals, complaints and grievances for all products.
• Review and interpret clinical documentation to apply appropriate criteria and policies.
• Coordinate clinical resolution with internal/external clinician support.
• Ensure timely, customer-focused responses in line with regulatory requirements.

Connaissances

Customer service

Behavioral health

Managed care

Formation

RN licensure

Description du poste

CVS Health is seeking an RN with an unrestricted license to manage appeals, complaints and grievances for all products. The role requires 3-5 years of Behavioral Health experience and familiarity with managed care. This is a full-time position based in Kentucky.

You will review clinical documentation, coordinate with clinicians, and ensure regulatory compliance while delivering timely, customer-focused resolutions. CVS Health offers comprehensive benefits and a supportive work environment.