Appeals Nurse Consultant
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Missouri • 🇺🇸 United States
Visit company websiteSalary
💰 $60,522 - $129,615 per year
Job Level
Mid-LevelSenior
About the role
- Responsible for intake, investigation and resolution of appeals, complaints and grievances scenarios for all products
- Ensure timely, customer focused response to appeals, complaints and grievances
- Identify trends and emerging issues and report and recommend solutions
- Review and resolve clinical documentation, clinical complaints and appeals
- Independently coordinate clinical resolution with internal/external clinician support as required
Requirements
- Experience in reading or researching benefit language
- Excellent verbal and written communication skills
- Excellent customer service skills
- RN with current unrestricted state licensure required
- 3-5 years of clinical experience required
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
clinical documentation reviewclinical complaint resolutionappeals investigationgrievance resolutionbenefit language research
Soft skills
verbal communicationwritten communicationcustomer serviceproblem-solvingtrend identification
Certifications
RN licensure