Appeals Nurse Consultant - Remote Position
DiscoveredCVS Health
Oklahoma City, OKRemoteexternalHealthcarePosted about 1 year ago (May 28, 2025)
About the role
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.This position will be working from home anywhere in the US.Standard business hours 8a-5p in time zone of residence
Position Summary
The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare appeals for participating providers. Primary duties may include, but are not limited to: Requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast-paced department. Must work independently as well as in a team environment while working remotely. Fast paced sedentary position, talking on the telephone, looking at computer screens, utilizing templates in Word, and typing on the computer.
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Required Qualifications@@/HD@@
• 3+ years of clinical experience required
• Active and unrestricted RN licensure in state of residence
Preferred Qualifications
• Managed Care experience
• Utilization Management experience
• Appeals experience
• Pre Certification experience
• Pre Authorization experience
Education
• Associates Degree minimum required
• Bachelors Degree preferred
Full time Pay Range
The typical pay range for this role is:$54,095.00 - $142,576.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: •
Affordable medical plan options,
a
401(k) plan
(including matching company contributions), and an
employee stock purchase plan
.
•
No-cost programs for all colleagues
including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
•
Benefit solutions that address the different needs and preferences of our colleagues
including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 05/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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