Clinical Claim Review Nurse

Job not on LinkedIn

🔥 7 minutes ago

🌾 North Dakota – Remote

🌾 North Dakota – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 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

• Review and evaluate clinical information and documentation related to outpatient therapy services • Review documentation and interpret data from clinical records or systems • Apply clinical decision-making, clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider claims • Independently coordinate clinical resolution 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 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 • Associate’s degree in Nursing or Diploma RN required • Bachelor’s in Science & Nursing preferred • Direct/hardwired internet connection to a modem/router within 7 feet of the computer, with minimum speeds of 50 Mbps download and 5 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure and private designated home virtual work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Ability to set up and 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 log in to secure systems such as VPN and EHR portals, secure computer screens, manage strong passwords and recognize suspicious emails or links • Ability to independently resolve common technical issues and contact IT when necessary • Openness to learning new skills as the workplace evolves • Experience with MedCompass, CEC, IOP, or clinical review experience with therapy review types preferred • Experience with adult and/or pediatric outpatient therapy preferred • Experience working in a multidisciplinary team 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 • CVS Health bonus, commission or short-term incentive program in addition to base pay • Company-provided equipment (keyboard, monitor, computer, headset, etc.)