Appeals Nurse Consultant

Job not on LinkedIn

🔥 14 hours ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $54.1k - $142.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.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

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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.

📋 Description

• Process the medical necessity of Medicare Part C appeals from members and providers • Request clinical information and conduct research • Extrapolate pertinent clinical information • Apply appropriate Medicare Guidelines • Navigate multiple computer system applications • Work independently and collaboratively in a remote, fast-paced department • Participate in scheduled weekend and holiday shifts • Support a team operating 7 days per week, 365 days per year

🎯 Requirements

• Must have active and unrestricted RN licensure in state of residence • Excellent verbal and written communication skills • Strong organizational skills • Associate's Degree in Nursing • Appeals Experience, Utilization Review, Medicare Experience preferred • Bachelor's Degree preferred • Ability to work independently and in a team environment while working remotely • Ability to work scheduled weekend and holiday rotations • Ability to work Monday–8am–4:30pm in your time zone • Ability to work in a fast-paced department and navigate multiple computer system applications

🏖️ 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