Skip to contentAppeals Nurse Consultant
| Company | CVS Health |
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| Location | Hartford, CT, USA |
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| Salary | $66575 – $142576 |
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| Type | Full-Time |
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| Degrees | |
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| Experience Level | Mid Level |
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Requirements
- Must have active and unrestricted Registered Nurse(RN) licensure in state of residence
- 3+ years clinical experience
Responsibilities
- Responsible for the review and resolution of clinical appeals
- Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues
- Independently coordinates the clinical resolution with internal/external clinician support as required
- This position may support UM, MPO, Coding, or Behavioral Health appeals.
Preferred Qualifications
- Appeals Experience
- Managed Care Experience
- Utilization review experience
- Proficiency with computer skills including navigating multiple systems
- Exceptional communication skills
- Time efficient, highly organized, and ability to multitask
