Clinical Claims Review Nurse

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

📋 Description

• Analyze and interpret clinical documentation from medical records or systems.

• Utilize clinical decision-making and relevant clinical criteria and policies for post-service claims.

• Independently coordinate clinical resolutions, seeking clinician/MD support as necessary.

• Serve as a resource for customer service and claims processing teams.

• Onboard new staff and provide cross-training to current team members.

• Detect trends and offer feedback to leadership regarding discrepancies or potential fraudulent activities.

• Stay updated with applicable laws, regulations, and internal processes to ensure compliance with organizational and state-specific requirements.

⛳️ Requirements

• Active, current, and unrestricted Registered Nurse license in the state of residence.

• Degree in Nursing (RN).

• At least 2–3 years of professional experience as a licensed Registered Nurse (RN), or equivalent clinical experience.

• Strong analytical abilities to evaluate medical claims.

• Bachelor's degree.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.