Clinical Claim Review Nurse

Job not on LinkedIn

🔥 3 hours ago

🌾 North Dakota – Remote

🌾 North Dakota – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 evaluate clinical information and documentation related to outpatient therapy services • Interpret data from clinical records or systems • Apply appropriate clinical criteria and policies in accordance with regulatory and accreditation requirements • Make clinical decisions for member and/or provider claims • Coordinate clinical resolution independently, with clinician/MD support as required • Act as a resource for customer service and claims processing areas • Work Monday–Friday, 8am–5pm in the candidate’s residence time zone

🎯 Requirements

• 2+ years of clinical experience as an RN • Active unrestricted RN licensure in the state of residence • Experience using Microsoft Office products, including Teams, Outlook and Excel • Previous experience using Internet Explorer and Google Chrome to utilize review resources and conduct reviews • Direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 50 Mbps download and 5 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure and private designated home work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Ability to use multiple monitors and navigate multiple applications simultaneously • Ability to communicate via email, calendar invites, Teams messaging and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer security practices, including locking screens, managing strong passwords and recognizing suspicious emails or links • Ability to troubleshoot common technical issues and contact IT when needed • Openness to learning new workplace skills • Minimum Associate’s degree in Nursing or Diploma RN • Experience with MedCompass, CEC, IOP, or clinical review of therapy types preferred • Experience with adult and/or pediatric outpatient therapy preferred, including occupational therapy, physical therapy, speech therapy, chiropractic or acupuncture • Experience working in a multidisciplinary team preferred • Bachelor’s in Science & Nursing preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • CVS Health bonus, commission or short-term incentive program eligibility

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