Appeals Nurse Consultant

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

📋 Description

• Evaluate and resolve clinical appeals.

• Analyze documentation and interpret information from clinical records.

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

• Address issues raised by members and providers.

• Independently coordinate clinical resolutions with both internal and external clinician support as necessary.

• Assist with Utilization Management (UM), including expedited appeals, Medical Policy Oversight (MPO), coding, or Behavioral Health appeals.

⛳️ Requirements

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

• Have a minimum of 3 years of clinical experience.

• Hold at least an Associate's Degree.

• Preferred experience in Appeals, Managed Care, or Utilization Review.

• Competence in computer skills, including navigating through multiple systems.

• Excellent communication abilities.

• Highly organized, time-efficient, and capable of multitasking.

• Maintain a dedicated workspace that is free from interruptions.

• Arrange separate care for dependents during working hours.

• Availability to work Monday to Friday, from 8:00 AM to 5:00 PM local time.

• May require occasional weekend and holiday on-call coverage.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Potential for CVS Health bonuses, commissions, or short-term incentive programs in addition to the base pay range.