Appeals Nurse Consultant (Remote)
CVS Health•Work At Home-Ohio, CT
•$60,522 - $129,615•Remote
About The Position
CVS Aetna is seeking a dedicated Appeals Nurse Consultant to join our remote team. In this role, you will play a critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical judgment and regulatory knowledge.
Requirements
- Must have active and unrestricted RN licensure in state of residence.
- 3+ years clinical experience.
- Associate's Degree minimum.
Nice To Haves
- Appeals, Managed Care, or Utilization Review experience.
- Proficiency with computer skills including navigating multiple systems.
- Exceptional communication skills.
- Time efficient, highly organized, and ability to multitask.
Responsibilities
- Responsible for the review and resolution of clinical appeals.
- Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues.
- Independently coordinates the clinical resolution with internal/external clinician support as required.
- This position may support UM (includes expedited), MPO, Coding, or Behavioral Health appeals.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
