Appeals Nurse Consultant

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

📋 Description

• Evaluate and resolve clinical appeals.

• Analyze documentation and interpret data from clinical records.

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

• Address issues raised by members and providers.

• Independently coordinate clinical resolutions with necessary support from internal and external clinicians.

• Assist in Utilization Management (UM), encompassing expedited appeals, Managed Care Organization (MPO), Coding, or Behavioral Health appeals.

• Work full-time in a remote setting.

⛳️ Requirements

• Active and unrestricted RN license in your state of residence.

• Minimum of 3 years of clinical experience.

• An Associate's Degree is required at a minimum.

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

• Proficiency in computer skills, including the ability to navigate multiple systems, is preferred.

• Strong communication skills are preferred.

• Ability to manage time efficiently, stay highly organized, and multitask is preferred.

• A dedicated workspace free of interruptions is required.

• Care arrangements for dependents should be in place during work hours.

• Must be available for standard hours from Monday to Friday, 8:00 AM to 5:00 PM local time.

• Occasional on-call coverage during weekends and holidays may be necessary.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being, subject to eligibility.