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Appeals Nurse Consultant


Mid Level


Not defined

16 Nov → 16 Dec

CVS Health

Woonsocket, RI 02895, USA

About Company

CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners.
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Job Description

CVS Health is looking for Appeals Nurse Consultant. This is a Telework position.

COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Job Responsibilities

  • Responsible for the review and resolution of clinical appeals.
  • Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues.
  • Independently coordinates the clinical resolution with internal/external clinician support as required.
  • This position will support Medicaid DRG appeals.

Requirements / Qualifications

  • RN license active and in good standing
  • 3+ years of clinical experience
  • Associate degree required.
  • Appeals Experience (preferred)
  • Managed Care Experience (preferred)

How To Apply

Apply through GoRemotely.

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