Appeals Nurse Consultant

CVS Health

Appeals Nurse Consultant ensuring fair and accurate resolution of clinical appeals at CVS Health. Critical role with high standards, remote coordination, and legal compliance.

Posted 5/31/2026full-timeRemote • Connecticut • 🇺🇸 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
Independently coordinates the clinical resolution with internal/external clinician support as required
Support UM, MPO, Coding, or Behavioral Health appeals.

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

Benefits

Comp & perks

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical appeals resolutiondata interpretationclinical documentation reviewutilization reviewmanaged carecodingbehavioral health appeals

Soft Skills

communicationtime managementorganizational skillsmultitasking

Certifications

active RN licensure