Appeals Nurse Consultant (Remote)

CVS Health • Work from home, CT

348d • $66,575 - $142,576 • Remote

About The Position

The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare appeals for participating providers. Primary duties may include, but are not limited to: Requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast-paced department. Must work independently as well as in a team environment while working remotely. Fast paced sedentary position, talking on the telephone, looking at computer screens, utilizing templates in Word, and typing on the computer.

Requirements

• 3+ years of clinical experience required
• Active and unrestricted RN licensure in state of residence

Nice To Haves

• Coding experience
• Managed Care experience
• Utilization Management experience
• Appeals experience
• Pre Certification experience
• Pre Authorization experience

Responsibilities

• Process medical necessity of Medicare appeals for participating providers
• Request clinical information and conduct research
• Extrapolate pertinent clinical data
• Apply appropriate Medicare guidelines
• Navigate through multiple computer system applications
• Work independently and in a team environment
• Communicate effectively via telephone and computer

Benefits

• Full range of medical, dental, and vision benefits
• 401(k) retirement savings plan
• Employee Stock Purchase Plan
• Fully-paid term life insurance
• Short-term and long-term disability benefits
• Well-being programs
• Education assistance
• Free development courses
• CVS store discount
• Discount programs with participating partners
• Paid Time Off (PTO)
• Paid holidays throughout the calendar year

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Health and Personal Care Retailers
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees