We are looking for an experienced and compassionate Appeals Nurse Consultant to join our team at CVS Health. This position requires a highly organized professional with excellent clinical judgement and the ability to work effectively with both internal and external stakeholders. As an Appeals Nurse Consultant, you will be responsible for providing clinical support and expertise to ensure the… timely, accurate and effective resolution of appeals for CVS Health and its clients. To be successful in this role, you must possess a valid registered nurse license, as well as experience in clinical appeals and/or case management. Additionally, you should have excellent written and verbal communication skills, strong problem-solving skills, and the ability to make sound clinical decisions in a timely manner. If you are a passionate and detail-oriented professional who is ready to take on a challenging role within CVS Health, we would love to hear from you!
Responsibilities of an Appeals Nurse Consultant:
Provide clinical support and expertise to resolve appeals for CVS Health and its clients.
Utilize clinical judgement to make sound clinical decisions in a timely manner.
Monitor and review appeals to ensure accuracy and effectiveness.
Collaborate with internal and external stakeholders to ensure timely resolution of appeals.
Maintain a valid registered nurse license.
Utilize problem-solving and critical thinking skills to identify and address issues.
Provide clear and concise written and verbal communication regarding appeals.
Monitor and follow up on appeals to ensure timely resolution.
Ensure compliance with applicable laws, regulations, and policies.
Review and assess medical records to determine clinical appropriateness of appeals.
CVS Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics
