Appeals Nurse Consultant
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Appeals Nurse Consultant ensuring fair and accurate resolution of clinical appeals at CVS Health. Critical role with high standards, remote coordination, and legal compliance.
Responsibilities:
- Responsible for the review and resolution of clinical appeals
- Reviews documentation and interprets data obtained from clinical records
- Independently coordinates the clinical resolution with internal/external clinician support as required
- Support UM, MPO, Coding, or Behavioral Health appeals.
Requirements:
- Must have active and unrestricted RN licensure in state of residence
- 3+ years clinical experience
- Appeals, Managed Care, or Utilization Review experience preferred
- Proficiency with computer skills including navigating multiple systems
- Exceptional communication skills
- Time efficient, highly organized, and ability to multitask
- Associate's Degree minimum.
Benefits:
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
Similar Jobs
Business Card Consultant
Business Card Consultant developing profitable business account relationships for U.S. Bank. Identifying business opportunities and promoting the organization's products and services to meet client needs.
National Card Consultant
National Card Consultant driving new business through field-based sales at U.S. Bank. Sourcing new opportunities and engaging with high-value business clients as a financial consultant.
Business Card Consultant
Develop profitable business account relationships and increase profitability from existing and new accounts at U.S. Bank. Identify business opportunities and make sales presentations to clients.
Oracle APEX Technical Consultant
Consultor(a) Técnico(a) Oracle APEX desenvolvendo soluções em Oracle Retail SIOCS. Atuando em sustentação, customização e suporte de operações de inventário.
Shell Select Store Consultant, III
Consultant for Shell Select managing B2B2C retail relationships with franchisees. Driving performance through business consultancy and ensuring operational standards across locations.
Senior Consultant – Cadence and Decision Tree
Senior Consultant optimizing healthcare decision trees and EHR platform for healthcare organizations. Collaborating with teams to enhance patient outcomes via decision logic design.
Senior Compensation Consultant
Senior Compensation Consultant responsible for developing and administering compensation programs at Providence. Focus on competitive pay structures, job analysis, and market evaluations.
Grants Consultant – Scientific Research Focus
Grants Consultant supporting higher education clients in scientific research grant proposal development. Collaborating with proposal teams to deliver client-ready documents while optimizing competitiveness.
Senior Consultant
Senior Consultant providing technical IAM solutions for complex Federal engagements in identity and access management. Leading architectural design and client relations in a remote capacity.
Pedagogical Consultant
Consultant providing pedagogical training and support to schools in Brazil. Collaborating with educators to enhance socio-emotional learning experiences for students.
Senior Technical Advisory Consultant – Workday Success Plans
Senior Technical Advisory Consultant helping customers drive business value from Workday Extend applications. Provides guidance and coaching on technical designs and drives adoption of Workday tools.
Project Consultant
Project Consultant at Resource Solutions managing mission-critical accounting and finance projects for large clients. Overseeing financial operations and implementing internal controls in various industries.
Senior PS Consultant
Senior Consultant deploying AI-powered solutions for customer experience using Genesys Cloud. Influencing strategy, delivery, and continuous improvements with cross-functional collaboration.
Consultant
Consultant supporting special populations case management projects in North Carolina. Managing client relationships and ensuring consistent service delivery with a collaborative approach.
Senior MM Consultant
Senior MM Consultant focusing on S/4HANA's procurement and inventory management. Involves configuration and collaboration for process improvements.
Consultant, Digitalization for ERP Software
Consultant contributing to public sector digital transformation through ERP software. Managing projects and enhancing service offerings with a focus on financial processes.
Oracle Consultant
Associate Consultant supporting implementation of Oracle Cloud ERP Financials solutions with analysis, configuration, and client engagement. Opportunity for hands-on expertise in ERP modules and financial processes.
Delivery Consultant I
Accounting Consultant managing accounting reconciliations and operations team outputs for Defined Contribution clients. Supporting colleague development through coaching in a remote environment.
Medical Records Management Testing & Validation Consultant
Testing & Validation Consultant supporting hands-on testing of medical records management application with a focus on regulatory compliance within healthcare.
Junior Associate Technical Consultant
Technical Consultant responsible for developing Salesforce solutions for clients at Salesforce. Collaborating with teams and managing implementations remotely across geographies.