Appeals Nurse Consultant

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🔥 1 minute ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $60.5k - $129.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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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 in a fast-paced department • Work independently and in a team environment while working remotely • Participate in a scheduled rotation that includes some weekends and holidays • Support the Medicare Clinical Appeals Team C Member/Non-Par Team, which operates 7 days per week, 365 days per year

🎯 Requirements

• 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 preferred • Utilization Review experience preferred • Medicare experience preferred • Some weekends and holidays required on a scheduled rotation

🏖️ Benefits

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