Appeals Nurse Consultant (Remote)

at  CVS Health

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
This position will be working from home anywhere in the US.
Standard business hours 8a-5p in time zone of residence Monday - Friday.

POSITION SUMMARY

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.

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
Medical Coding experience

EDUCATION

Associates Degree OR Diploma RN required
Bachelors Degree preferred

Please refer the Job description for details