CVS Health is hiring an Appeals Nurse Consultant to join their remote team. Aetna, a CVS Health company, is looking for a dedicated nurse to process the medical necessity of Medicare appeals for participating providers. You'll help ensure compliance and compassionate care delivery within a dynamic healthcare environment.
What You'll Do
- Request clinical information, research cases, extrapolate pertinent clinical data, and apply appropriate Medicare Guidelines.
- Navigate multiple computer system applications in a fast-paced department.
- Work independently and collaboratively while operating in a fully remote environment.
- Review documentation and interpret data from clinical records to apply correct clinical criteria and policies.
- Ensure compliance with regulatory and accreditation requirements for provider issues.
- Review and resolve clinical appeals.
What We're Looking For
- Active and unrestricted RN licensure in your state of residence.
- 3+ years of clinical experience.
Nice to Have
- Experience with Appeals, Managed Care, or Utilization Review.
- Pre Certification or Pre Authorization experience.
- Proficiency with computer skills, including navigating multiple systems.
- Exceptional communication skills.
- Ability to be time efficient, highly organized, and multitask.
Benefits & Compensation
- Compensation range: $60,522.00 - $129,615.00
- 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.
Work Mode
This position is designated as global remote, allowing you to work from your location.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
