RN Clinical Appeals Specialist

CVS Health; Oklahoma City (OK); On-site; USD 54,000 - 117,000; Full time

Benefits offered by this job

Medical coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Oklahoma City is seeking a registered nurse to manage intake, investigation and resolution of appeals, complaints and grievances for all products, coordinating responses across teams. The role emphasizes adherence to clinical criteria, regulatory standards and timely, customer-focused service.

You will review clinical documentation, collaborate with clinicians, and ensure accurate, policy-driven decisions.

Qualifications

• RN with current unrestricted state licensure
• 3-5 years of Behavioral Health experience
• Managed Care experience preferred
• Excellent customer service skills

Responsibilities

• Handle intake, investigation and resolution of appeals, complaints and grievances for all products
• Review and interpret clinical documentation against policies and regulatory requirements
• Coordinate clinical resolution with internal/external clinician support as needed
• Ensure timely, customer-focused responses and adherence to standards

Skills

Excellent customer service

Behavioral health experience

Managed care experience

Education

RN license

Job description

CVS Health in Oklahoma City is seeking a registered nurse to manage intake, investigation and resolution of appeals, complaints and grievances for all products, coordinating responses across teams. The role emphasizes adherence to clinical criteria, regulatory standards and timely, customer-focused service.

You will review clinical documentation, collaborate with clinicians, and ensure accurate, policy-driven decisions.