RN Clinical Claims Review & Resolution Specialist

CVS Health; Little Rock (AR); Vor Ort; USD 36.000 - 77.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental and vision

Paid time off

Retirement savings

Zusammenfassung

CVS Health is hiring a Clinical Claim Review Nurse to evaluate clinical information and determine claim eligibility based on policy, regulations, and plan benefits. The role involves reviewing records, applying criteria, and coordinating resolutions with clinicians to ensure accurate payment decisions.

Applicants should have an RN license and 2–3 years of professional RN experience, with strong analytical abilities and familiarity with confidential data handling.

Qualifikationen

• Active RN license required.
• 2–3 years of RN experience in clinical review or equivalent.
• Strong analytical skills to assess medical claims.

Aufgaben

• Review and interpret clinical documentation from medical records.
• Apply clinical criteria and policies for post-service claims.
• Coordinate clinical resolutions with clinician/MD support.

Kenntnisse

RN license

Clinical review

Analytical skills

Ausbildung

Associate Degree in Nursing

Bachelor of Science in Nursing

Jobbeschreibung

CVS Health is hiring a Clinical Claim Review Nurse to evaluate clinical information and determine claim eligibility based on policy, regulations, and plan benefits. The role involves reviewing records, applying criteria, and coordinating resolutions with clinicians to ensure accurate payment decisions.

Applicants should have an RN license and 2–3 years of professional RN experience, with strong analytical abilities and familiarity with confidential data handling.