Regional Consultant
AssetMark
Utilization Management Appeals Nurse Consultant
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Minnesota, Ohio, Virginia, West Virginia, Wisconsin • 🇺🇸 United States
Visit company websiteSalary
💰 $54,095 - $116,760 per year
Job Level
Mid-LevelSenior
About the role
- Administers review and resolution of clinical complaints and appeals
- Interprets data obtained from clinical records to apply appropriate clinical criteria and policies in compliance with regulatory and accreditation requirements for members and providers
- Coordinates clinical resolutions with internal and external support areas
Requirements
- 3+ years Utilization Management or Utilization Review experience
- 3+ years clinical nursing experience, with 1-3 years managed care experience in Utilization Review, Medical Claims Review, or other specific program experience as needed or equivalent experience
- 1+ year(s) of experience demonstrating knowledge of ICD-9, CPT coding and HCPC
- 1+ year(s) of experience demonstrating knowledge of clinical and medical policy, Milliman Care Guidelines (MCG), InterQual or other medically appropriate clinical guidelines, applicable State regulatory requirements, including the ability to easily access and interpret these guidelines
- Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
Utilization ManagementUtilization ReviewICD-9 codingCPT codingHCPC codingclinical policy knowledgeMilliman Care GuidelinesInterQualmedical claims reviewmanaged care experience
Certifications
Active RN licensemultistate licensure
