Appeals Nurse Consultant

This is a fully remote position, open to applicants in Connecticut.

📋 Description

• Evaluate and address clinical appeals.

• Analyze documentation and interpret data from clinical records.

• Implement relevant clinical criteria and policies in accordance with regulatory and accreditation standards.

• Independently facilitate clinical resolutions with both internal and external clinician support.

• Assist with UM, MPO, Coding, or Behavioral Health appeals.

• Work schedule is Monday to Friday, from 8:00 AM to 5:00 PM local time.

• Provide occasional weekend and holiday on-call coverage as necessary.

⛳️ Requirements

• Possession of an active and unrestricted RN license in the state of residence.

• A minimum of 3 years of clinical experience.

• At least an Associate's Degree is required.

• Experience in Appeals, Managed Care, or Utilization Review is preferred.

• Proficient computer skills, including the ability to navigate multiple systems, are preferred.

• Exceptional communication abilities are preferred.

• Time-efficient, highly organized, and capable of multitasking are preferred qualities.

• A dedicated workspace that is free from interruptions is necessary.

• Arrangements for dependent care during work hours must be established separately.

• Occasional weekend and holiday on-call coverage may be necessary.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.