Appeals Nurse Consultant
Description:
• The Appeals Nurse Consultant processes the medical necessity of Medicare Part C appeals for members and providers.
• Production role within the Nurse Appeal Consultant job code; works remotely.
• Responsibilities include requesting clinical, researching, extrapolating pertinent clinical information, applying Medicare Guidelines, navigating multiple computer systems.
• Must work independently and in a team; remote work.
• Operates 7 days per week, 365 days per year; includes scheduled Thursdays, Fridays, weekends and holidays.
• Requires ability to meet deadlines in deadline-intensive environment; adaptability.
• Read and understand workflows, policies, procedures; data entry via typing; data review of appeals.
• Collaborate with internal partners and external entities; gather information; provide written recommendations or decisions consistent with CVS Health and Medicare guidelines.
• Attend department meetings; meticulous documentation; prepare templates using structured decision-making frameworks.
• Schedule: Thursday-Sunday, 8am-6:30pm
Requirements:
• active and unrestricted RN licensure in state of residence
• 3+ Years Clinical Experience
• Excellent verbal and written communication skills
• Strong organizational skills
Benefits:
• Affordable medical plan options
• a 401(k) plan (including matching company contributions)
• an employee stock purchase plan
• wellness screenings
• tobacco cessation and weight management programs
• confidential counseling and financial coaching
• paid time off
• flexible work schedules
• family leave
• dependent care resources
• colleague assistance programs
• tuition assistance
• retiree medical access
• many other benefits depending on eligibility
• For more information, visit https://jobs.cvshealth.com/us/en/benefits
Apply Now
Apply Now
• The Appeals Nurse Consultant processes the medical necessity of Medicare Part C appeals for members and providers.
• Production role within the Nurse Appeal Consultant job code; works remotely.
• Responsibilities include requesting clinical, researching, extrapolating pertinent clinical information, applying Medicare Guidelines, navigating multiple computer systems.
• Must work independently and in a team; remote work.
• Operates 7 days per week, 365 days per year; includes scheduled Thursdays, Fridays, weekends and holidays.
• Requires ability to meet deadlines in deadline-intensive environment; adaptability.
• Read and understand workflows, policies, procedures; data entry via typing; data review of appeals.
• Collaborate with internal partners and external entities; gather information; provide written recommendations or decisions consistent with CVS Health and Medicare guidelines.
• Attend department meetings; meticulous documentation; prepare templates using structured decision-making frameworks.
• Schedule: Thursday-Sunday, 8am-6:30pm
Requirements:
• active and unrestricted RN licensure in state of residence
• 3+ Years Clinical Experience
• Excellent verbal and written communication skills
• Strong organizational skills
Benefits:
• Affordable medical plan options
• a 401(k) plan (including matching company contributions)
• an employee stock purchase plan
• wellness screenings
• tobacco cessation and weight management programs
• confidential counseling and financial coaching
• paid time off
• flexible work schedules
• family leave
• dependent care resources
• colleague assistance programs
• tuition assistance
• retiree medical access
• many other benefits depending on eligibility
• For more information, visit https://jobs.cvshealth.com/us/en/benefits
Apply Now
Apply Now