Appeals Nurse Consultant - Remote

Overview

The Appeals Nurse Consultant position at CVS Health involves processing Medicare appeals and requires a dedicated professional with clinical experience.

In Short

• Work from home anywhere in the US.
• Responsible for processing medical necessity of Medicare appeals.
• Request and analyze clinical information.
• Navigate multiple computer systems in a fast-paced environment.
• Work independently and as part of a team.
• Standard business hours: 8a-5p local time, Monday - Friday.
• Requires 3+ years of clinical experience.
• Active RN licensure required.
• Preferred experience in managed care and utilization management.
• Comprehensive benefits and competitive pay range.

Requirements

• 3+ years of clinical experience.
• Active and unrestricted RN licensure in state of residence.
• Managed care experience preferred.
• Utilization management experience preferred.
• Experience with appeals and pre-certification is a plus.
• Associates Degree minimum required; Bachelor's Degree preferred.
• Ability to work in a fast-paced environment.
• Strong communication skills.
• Proficient in Microsoft Word and computer navigation.
• Ability to work independently and collaboratively.

Benefits

• Affordable medical plan options.
• 401(k) plan with company matching.
• Employee stock purchase plan.
• Wellness screenings and counseling programs.
• Flexible work schedules and paid time off.
• Tuition assistance and dependent care resources.
• Comprehensive benefits tailored to employee needs.
• Retiree medical access.
• Short-term incentive programs available.
• Commitment to fostering a diverse workplace.