RN Clinical Claims Review Specialist

CVS Health; Louisiana; Sur place; USD 36 000 - 77 000; Plein temps

Résumé du poste

CVS Health is seeking a Clinical Claim Review Nurse to evaluate post-service medical claims using clinical criteria and policies. The role emphasizes independent coordination with clinicians and adherence to confidentiality and regulatory requirements.

You will review documentation from medical records and systems to determine eligibility for payment. Responsibilities include collaborating with internal teams, providing training to staff, and identifying trends to improve processes while staying

Qualifications

• RN licensure required and active license.
• Strong analytical skills to assess medical claims.
• 2–3 years of professional RN experience or equivalent.

Responsabilités

• Review and interpret clinical information for claims.
• Coordinate with clinicians to resolve complex cases.
• Apply clinical criteria while ensuring regulatory compliance.
• Assist customer service and claims teams as a resource.
• Train staff and contribute to cross-training initiatives.

Connaissances

RN licensure

Analytical skills

Formation

Associates Degree in Nursing

Bachelor of Science in Nursing preferred

Outils

Microsoft Suite

Description du poste

CVS Health is seeking a Clinical Claim Review Nurse to evaluate post-service medical claims using clinical criteria and policies. The role emphasizes independent coordination with clinicians and adherence to confidentiality and regulatory requirements.

You will review documentation from medical records and systems to determine eligibility for payment. Responsibilities include collaborating with internal teams, providing training to staff, and identifying trends to improve processes while staying