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Appeals Nurse Consultant (remote) - Remote Eligible

Process Medicare appeals by analyzing clinical data and applying guidelines effectively.
Remote
Mid-Level
$66,575 - 142,576 USD / year
3 weeks ago
CVS Health

CVS Health

CVS Health is a leading pharmacy and healthcare company offering prescriptions, products, and wellness services.

✨ About The Role

- The Appeals Nurse Consultant will be responsible for processing Medicare appeals related to medical necessity for participating providers. - Key responsibilities include requesting clinical information, conducting research, and applying appropriate Medicare guidelines. - The position requires navigating multiple computer systems in a fast-paced environment. - The role is primarily sedentary, involving extensive use of a computer and telephone. - Standard business hours are Monday to Friday, from 8 AM to 5 PM in the employee's time zone.

âš¡ Requirements

- The ideal candidate will have at least 3 years of clinical experience, demonstrating a strong background in nursing. - An active and unrestricted RN licensure in the state of residence is essential for this role. - Experience in coding, managed care, and utilization management will be highly beneficial. - The successful applicant should be comfortable working independently as well as collaboratively in a remote team environment. - Strong communication skills are necessary, as the role involves talking on the telephone and interacting with various stakeholders.
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Appeals Nurse Consultant (remote) - Remote Eligible
Remote
$66,575 - 142,576 USD / year
Remote
About CVS Health
CVS Health is a leading pharmacy and healthcare company offering prescriptions, products, and wellness services.