RN Clinical Claims Reviewer

CVS Health; Lansing (MI); On-site; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is hiring a Clinical Claim Review Nurse in Lansing, MI. You will review and interpret clinical documentation from medical records to determine eligibility and payment for post-service claims.

The role requires applying clinical criteria, coordinating resolutions with clinicians, and ensuring compliance with state and federal laws. The position offers full-time hours, with a base pay range and eligibility for CVS Health’s bonus/short-term incentive programs.

Qualifications

• RN with active license
• 2–3 years of professional nursing experience
• Experience evaluating medical claims and applying clinical criteria

Responsibilities

• Review and evaluate clinical information for post-service claims
• Apply appropriate clinical policies and regulatory requirements
• Coordinate clinical resolutions with clinicians as needed
• Support claims processing teams and provide training as needed
• Identify trends and report discrepancies or potential fraud
• Maintain compliance with laws and internal workflows

Skills

Analytical skills

Clinical decision making

Education

Associates Degree in Nursing

RN license

Tools

Microsoft Suite

Job description

CVS Health is hiring a Clinical Claim Review Nurse in Lansing, MI. You will review and interpret clinical documentation from medical records to determine eligibility and payment for post-service claims.

The role requires applying clinical criteria, coordinating resolutions with clinicians, and ensuring compliance with state and federal laws. The position offers full-time hours, with a base pay range and eligibility for CVS Health’s bonus/short-term incentive programs.