CVS Health

Appeals Nurse Consultant - Remote Position

Posted on

May 26, 2025

Job Type

Full-Time

Role Type

Clinical Operations

License

RN

State License

Mississippi

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Company Description

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Description

This position will be working from home anywhere in the US. Standard business hours 8a-5p in time zone of residence Monday - Friday.

Requirements

Required Qualifications: 3+ years of clinical experience required Active and unrestricted RN licensure in state of residence Preferred Qualifications: Managed Care experience Utilization Management experience Appeals experience Pre Certification experience Pre Authorization experience Education: Associates Degree minimum required Bachelors Degree preferred

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Responsibilities

The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare appeals for participating providers. Primary duties may include, but are not limited to: Requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast-paced department. Must work independently as well as in a team environment while working remotely. Fast paced sedentary position, talking on the telephone, looking at computer screens, utilizing templates in Word, and typing on the computer.

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