Appeals Nurse Consultant

Job not on LinkedIn

🔥 13 hours ago

⛰️ West Virginia – Remote

⛰️ West Virginia – Remote

💵 $54.1k - $116.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Review and resolve clinical appeals • Review documentation and interpret data from clinical records • Apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements • Address member and provider issues • Independently coordinate clinical resolution with internal and external clinician support as required • Support UM (including expedited), MPO, Coding, or Behavioral Health appeals • Work Monday–Friday, 8:00 AM to 5:00 PM local time • Provide occasional weekend and holiday on-call coverage as required

🎯 Requirements

• Active and unrestricted RN licensure in state of residence • 3+ years clinical experience • Associate's Degree minimum • 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 • Dedicated workspace free of interruptions • Dependents must have separate care arrangements during work hours

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay

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