Appeals Nurse Consultant (Remote)

CVS Health•Work At Home-Connecticut, CT

1d•$66,575 - $142,576•Remote

About The Position

CVS Aetna is seeking a dedicated Appeals Nurse Consultant to join its remote team. The role is responsible for supporting fair and accurate resolution of clinical appeals through sound clinical judgment and regulatory knowledge. The position may support UM (including expedited appeals), MPO, Coding, or Behavioral Health appeals. This is a 100% remote, full-time telework position with standard hours Monday through Friday, 8:00 AM to 5:00 PM local time. Candidates must have a dedicated workspace free of interruptions, and dependents must have separate care arrangements during work hours. Occasional weekend and holiday on-call coverage may be required.

Requirements

Active and unrestricted RN licensure in the state of residence.
At least 3 years of clinical experience.
Associate's Degree minimum.
Ability to maintain a dedicated, interruption-free remote workspace and arrange separate dependent care during work hours.

Nice To Haves

Experience in appeals, managed care, or utilization review.
Proficiency with computer skills, including navigating multiple systems.
Exceptional communication skills.
Time efficiency, strong organizational skills, and ability to multitask.

Responsibilities

Review and resolve clinical appeals.
Review documentation and interpret data from clinical records, applying appropriate clinical criteria and policies in accordance with regulatory and accreditation requirements for member and provider issues.
Independently coordinate clinical resolution with internal or external clinician support as required.
Provide support for UM (including expedited appeals), MPO, Coding, or Behavioral Health appeals, as assigned.