CVS Health is looking for an Appeals Nurse Consultant to join our remote team. At CVS Aetna, you will play a critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical judgment and regulatory knowledge, building a world of health around every consumer.
What You'll Do
- Review and resolve clinical appeals, applying appropriate clinical criteria and policies.
- Interpret data from clinical records in line with regulatory and accreditation requirements.
- Independently coordinate clinical resolution with internal or external clinician support as needed.
- Potentially support UM (including expedited), MPO, Coding, or Behavioral Health appeals.
- Provide occasional weekend and holiday on-call coverage.
What We're Looking For
- Active and unrestricted RN licensure in your state of residence.
- 3+ years of clinical experience.
- An Associate's Degree as a minimum requirement.
Nice to Have
- Experience with appeals, managed care, or utilization review.
- Proficiency with computer skills, including navigating multiple systems.
- Exceptional communication skills.
- Time-efficient, highly organized, and able to multitask.
Benefits & Compensation
- Compensation range: $54,095.00 - $116,760.00.
- Affordable medical plan options.
- 401(k) plan including matching company contributions.
- Employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation, weight management, confidential counseling and financial coaching.
- Paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
Work Mode
This role is designated as hybrid, offering a flexible work schedule.
CVS Health is committed to fostering a workplace where every colleague feels valued and that they belong. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
