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

• Address issues raised by members and providers.

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

• Assist with Utilization Management, including expedited appeals, Managed Care Operations, Coding, or Behavioral Health appeals.

⛳️ Requirements

• Active and unrestricted RN licensure in your 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.

• Competence in computer skills, including navigating multiple systems, is preferred.

• Excellent communication skills are preferred.

• Efficient time management, strong organizational abilities, and the capacity to multitask are preferred.

• A dedicated workspace free from interruptions is required.

• Dependents must have alternative care arrangements during work hours.

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

• Occasional weekend and holiday on-call coverage 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.