Appeals Nurse Consultant

CVS Health

Appeals Nurse Consultant ensuring fair and accurate resolution of clinical appeals at CVS Health. Responsible for reviewing documentation and applying clinical criteria in a remote role.

Posted 5/19/2026full-timeRemote • Ohio • 🇺🇸 United StatesMid-LevelSenior💰 $60,522 - $129,615 per yearWebsite

About the role

Key responsibilities & impact

Responsible for the review and resolution of clinical appeals.
Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies.
Independently coordinates the clinical resolution with internal/external clinician support as required.
This position may support UM, MPO, Coding, or Behavioral Health appeals.
Full-time telework position with standard hours of Monday–Friday, 8:00 AM to 5:00 PM.

Requirements

What you’ll need

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.
Time efficient, highly organized, and ability to multitask.
Exceptional communication skills.
Associate's Degree minimum.

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

clinical appeals resolutionclinical documentation reviewdata interpretationclinical criteria applicationutilization managementmanaged carecodingbehavioral health

Soft Skills

time managementorganizational skillsmultitaskingcommunication skills

Certifications

active RN licensure