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

• Manage clinical resolutions independently, seeking internal and external clinician support as necessary.

• Assist with UM (including expedited), MPO, Coding, or Behavioral Health appeals.

• Ensure fair and accurate resolution of clinical appeals.

⛳️ Requirements

• Current and unrestricted RN license in the state of residence.

• A minimum of 3 years of clinical experience.

• At least an Associate's Degree.

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

• Proficient in computer skills, including navigating various systems is preferred.

• Outstanding communication skills are preferred.

• Efficient with time management, highly organized, and capable of multitasking is preferred.

• A dedicated workspace that is free from interruptions.

• Arrangements for dependent care during work hours are required.

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

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

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• CVS Health bonus, commission, or short-term incentive program.