Experienced Appeals Nurse Consultant for Remote Medicare Appeals Processing

Bring Your Heart to CVS Health: Transforming Healthcare through Innovation and Care

At CVS Health, we're on a mission to redefine the healthcare landscape by making it more personal, convenient, and affordable. Our commitment to delivering exceptional health care is guided by our purpose: Bringing our heart to every moment of your health. As a leader in the healthcare industry, we're seeking a dedicated and experienced Appeals Nurse Consultant to join our team on a remote basis. If you're passionate about healthcare and looking for a role that offers challenge, growth, and the opportunity to make a real difference, we encourage you to explore this exciting opportunity.

About the Role: Shaping the Future of Medicare Appeals

The Appeals Nurse Consultant is a critical role within our organization, responsible for processing Medicare appeals for participating providers with precision and care. As an Appeals Nurse Consultant, you will be the cornerstone of our appeals process, ensuring that our decisions are informed, fair, and compliant with Medicare guidelines. This is a remote position that requires a high level of self-motivation, excellent communication skills, and the ability to work effectively in a fast-paced environment.

Key Responsibilities: Driving Success in Medicare Appeals

• Process Medicare appeals with a focus on medical necessity, ensuring compliance with relevant guidelines and regulations.
• Request and review clinical information from providers to inform appeal decisions.
• Apply Medicare guidelines and policies to make informed decisions on appeals.
• Navigate multiple computer system applications to access and manage appeal information.
• Utilize strong analytical and problem-solving skills to extrapolate pertinent clinical information.
• Work independently and as part of a remote team to achieve departmental goals and objectives.
• Communicate effectively with providers and internal stakeholders via telephone and written correspondence.
• Maintain productivity and efficiency in a fast-paced, sedentary role that involves extensive computer work and telephone interactions.

Qualifications: The Ideal Candidate

To excel in this role, you must possess a strong clinical background and a deep understanding of Medicare guidelines and processes. The ideal candidate will have:

• A minimum of 3 years of clinical experience in a relevant healthcare setting.
• Active and unrestricted RN licensure in the state of residence.
• Associate's Degree or Diploma in Nursing; Bachelor's Degree preferred.

• Experience in Managed Care, Utilization Management, DRG, or Appeals processing.
• A proven track record of working effectively in a fast-paced, remote environment.
• Strong analytical and problem-solving skills, with the ability to interpret complex clinical data.

Skills and Competencies: The Keys to Success

To succeed as an Appeals Nurse Consultant, you will need to demonstrate a range of skills and competencies, including:

• Strong clinical knowledge and understanding of Medicare guidelines and regulations.
• Excellent analytical and problem-solving skills, with the ability to interpret complex data.
• Effective communication and interpersonal skills, with the ability to interact with providers and internal stakeholders.
• The ability to work independently and as part of a remote team.
• Proficiency in Microsoft Office, particularly Word, and the ability to learn new computer systems and applications.
• Strong organizational and time management skills, with the ability to prioritize tasks and manage multiple projects simultaneously.

Career Growth Opportunities and Learning Benefits

At CVS Health, we're committed to the growth and development of our colleagues. As an Appeals Nurse Consultant, you will have access to a range of training and development opportunities, including:

• Comprehensive onboarding and training programs to ensure your success in the role.
• Ongoing professional development opportunities, including education assistance and free development courses.
• The opportunity to work with a talented and experienced team of healthcare professionals.
• Career advancement opportunities within the organization, with a clear path for progression.

Work Environment and Company Culture

As a remote colleague, you will be part of a dynamic and distributed team that values flexibility, collaboration, and innovation. Our company culture is built on our Heart At Work Behaviors, which emphasize the importance of putting our heart into every moment of our work. We offer a supportive and inclusive work environment that encourages colleagues to bring their whole selves to work.

Compensation, Perks, and Benefits

We offer a competitive compensation package that includes a base salary range of $60,522.80 - $129,615.20, depending on experience and qualifications. In addition to your base salary, you will be eligible for a CVS Health bonus, commission, or short-term incentive program. We also offer a comprehensive benefits package, including:

• Medical, dental, and vision benefits.
• A 401(k) retirement savings plan and Employee Stock Purchase Plan.
• Term life insurance and short-term and long-term disability benefits.
• Well-being programs, education assistance, and free development courses.
• A CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) and paid holidays throughout the calendar year.

Join Our Team: Make a Difference in Healthcare

If you're a motivated and experienced Appeals Nurse Consultant looking for a challenging and rewarding role, we encourage you to apply now. At CVS Health, we're committed to transforming the healthcare landscape and making a positive impact on the lives of our customers. Join our team and be part of a dynamic and innovative organization that is shaping the future of healthcare.

Don't miss this opportunity to bring your heart to CVS Health and make a real difference in the lives of others. Apply today!