Member/Non-Par Provider Appeals Nurse Consultant WEEKENDS

CVS Health•Work At Home-Connecticut, CT

1d•$66,575 - $142,576•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is considered a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include, but are not limited to: requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigating through multiple computer system applications in a fast paced department. Must work independently as well as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365 days per year. This position requires Thursday, Friday, and every weekend and holidays on a scheduled rotation.

Requirements

Active and unrestricted RN licensure in state of residence
Excellent verbal and written communication skills.
Strong organizational skills

Nice To Haves

Appeals Experience
Utilization Review
Medicare Experience

Responsibilities

Processing the medical necessity of Medicare Part C appeals from both members and providers.
Requesting clinical information.
Researching clinical information.
Extrapolating pertinent clinical information.
Applying appropriate Medicare Guidelines.
Navigating through multiple computer system applications.