Appeals Nurse Consultant

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

📋 Description

• Evaluate and address clinical appeals

• Analyze documentation and interpret information from clinical records

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

• Resolve issues for members and providers

• Independently manage clinical resolutions with necessary internal and external clinician support

• Assist in Utilization Management, including expedited appeals, Medical Policy Oversight, Coding, or Behavioral Health appeals

• Adhere to standard working hours from Monday to Friday, 8:00 AM to 5:00 PM local time

⛳️ Requirements

• Current and unrestricted RN licensure in the state of residence

• A minimum of 3 years of clinical experience

• At least an Associate's Degree

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

• Strong computer skills, including the ability to navigate multiple systems

• Excellent communication abilities

• Efficient in time management, highly organized, and capable of multitasking

• A dedicated workspace that is free from interruptions

• Arrangements for dependent care during work hours

• Willingness to be available for occasional on-call coverage during weekends and holidays

🏝️ Benefits

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

• Medical insurance coverage

• Dental insurance coverage

• Vision insurance coverage

• Paid time off

• Retirement savings options

• Wellness programs

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