Clinical Claim Review Nurse

Job not on LinkedIn

🔥 39 minutes ago

🏈 Alabama, Arizona, +14 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote 🦌 Connecticut – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🏈 Ohio – Remote 🦀 Maryland – Remote 🚗 Michigan – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🍑 Georgia – 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.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.

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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 interpret clinical documentation from medical records and other systems • Apply clinical judgment, established clinical criteria, and policies to evaluate post-service claims • Coordinate clinical resolutions independently, consulting clinicians or physicians as needed • Serve as a clinical resource to customer service and claims processing teams • Support training and cross-training of team members • Identify trends, discrepancies, or potential fraud concerns and escalate findings to leadership • Maintain current knowledge of applicable laws, regulations, policies, and workflows to ensure compliance

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license • Minimum of 2 years of professional experience as a Registered Nurse (RN) in any clinical setting or specialty area • Strong analytical and critical thinking skills • Ability to review, interpret, and evaluate medical claims and clinical documentation • Associate's or Bachelor's degree in Nursing (RN) from an accredited program • Proficiency with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar platforms such as Google Workspace • Strong digital communication skills, including email, Teams messaging, virtual meetings, and calendar management • 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 • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Ability to work within the state and city where currently living • Ability to use multiple monitors and navigate multiple applications • Ability to log in to secure systems such as VPN and EHR portals • Ability to manage strong passwords and recognize suspicious emails or links • Ability to troubleshoot common technical issues • Openness to learning new skills as the workplace environment evolves

🏖️ Benefits

• Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Medical, dental, and 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 eligibility in addition to base pay

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