Appeals Nurse Consultant - Remote

Overview

The Appeals Nurse Consultant at CVS Health is responsible for processing Medicare appeals, ensuring compliance with clinical criteria and policies while working in a remote environment.

In Short

• Process medical necessity of Medicare appeals for providers.
• Request and analyze clinical documentation.
• Navigate multiple computer systems in a fast-paced environment.
• Review and resolve clinical appeals.
• Work independently and as part of a team remotely.
• Maintain a dedicated workspace free of interruptions.
• Full-time position with standard hours Monday to Friday.
• Must have active RN licensure.
• 3+ years of clinical experience required.
• Competitive salary and benefits offered.

Requirements

• Active and unrestricted RN licensure in state of residence.
• 3+ years of clinical experience.
• Experience in appeals or managed care preferred.
• Proficient in navigating multiple computer systems.
• Exceptional communication skills.
• Organized and able to multitask effectively.
• Associates Degree minimum or Diploma RN required.
• Bachelor's Degree preferred.

Benefits

• Affordable medical plan options.
• 401(k) plan with matching contributions.
• Employee stock purchase plan.
• No-cost wellness programs.
• Flexible work schedules.
• Paid time off and family leave.
• Tuition assistance available.
• Comprehensive benefits for employees and families.