Appeals Nurse Consultant

Job not on LinkedIn

22 hours ago

🌵 Arizona – Remote

Although this job is listed in Arizona, this company may be open to hiring remote in other states.

⛰️ Colorado – Remote

Although this job is listed in Colorado, this company may be open to hiring remote in other states.

+3 more states

🌵 Arizona – Remote ⛰️ Colorado – Remote 🚗 Michigan – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote

💵 $60.5k - $129.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

Apply Now

Receive Emails with Similar Jobs

CVS Health

WebsiteLinkedInAll Job Openings

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• 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 • Support UM (includes expedited), MPO, Coding, or Behavioral Health appeals

🎯 Requirements

• Must have active and unrestricted RN licensure in state of residence • 3+ years clinical experience • Appeals, Managed Care, or Utilization Review experience preferred • Proficiency with computer skills including navigating multiple systems • Exceptional communication skills • Time efficient, highly organized, and ability to multitask • Associate's Degree minimum

🏖️ Benefits

• 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 and weight management programs, confidential counseling, and financial coaching • Benefit solutions that address the different needs and preferences of our colleagues including 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