Appeals Nurse Consultant

Description: • The Appeals Nurse Consultant processes the medical necessity of Medicare Part C appeals for members and providers. • Production role within the Nurse Appeal Consultant job code; works remotely. • Responsibilities include requesting clinical, researching, extrapolating pertinent clinical information, applying Medicare Guidelines, navigating multiple computer systems. • Must work independently and in a team; remote work. • Operates 7 days per week, 365 days per year; includes scheduled Thursdays, Fridays, weekends and holidays. • Requires ability to meet deadlines in deadline-intensive environment; adaptability. • Read and understand workflows, policies, procedures; data entry via typing; data review of appeals. • Collaborate with internal partners and external entities; gather information; provide written recommendations or decisions consistent with CVS Health and Medicare guidelines. • Attend department meetings; meticulous documentation; prepare templates using structured decision-making frameworks. • Schedule: Thursday-Sunday, 8am-6:30pm Requirements: • active and unrestricted RN licensure in state of residence • 3+ Years Clinical Experience • Excellent verbal and written communication skills • Strong organizational skills Benefits: • Affordable medical plan options • a 401(k) plan (including matching company contributions) • an employee stock purchase plan • 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 • many other benefits depending on eligibility • For more information, visit https://jobs.cvshealth.com/us/en/benefits Apply tot his job Apply To this Job