# Appeals Nurse Consultant

**Company**: CVS Health
**Location**: Work from home, CT
**Work arrangement**: remote
**Job type**: full-time
**Salary**: $66,575.00 - $142,576.00
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/CT---Work-from-home/Appeals-Nurse-Consultant--Remote-_R1071657?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/appeals-nurse-consultant-a93794ec-53a/

## Description

CVS Aetna is seeking a dedicated Appeals Nurse Consultant to join our remote team. In this role, you will play a critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical judgment and regulatory knowledge.

**Key Responsibilities**

- 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 in line with regulatory and accreditation requirements for member and provider issues.

- Independently coordinates the clinical resolution with internal/external clinician support as required.

- This position may support UM (includes expedited), MPO, Coding, or Behavioral Health appeals.

- This is a full-time telework position with standard hours of Monday–Friday, 8:00 AM to 5:00 PM (local time).

- Occasional weekend and holiday on-call coverage may be required.

**Remote Work Expectations**

- This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.

- Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

**Required Qualifications**

- Must have active and unrestricted RN licensure in state of residence.

- 3+ years clinical experience.

**Preferred Qualifications**

- Appeals, Managed Care, or Utilization Review experience.

- Proficiency with computer skills including navigating multiple systems.

- Exceptional communication skills.

- Time efficient, highly organized, and ability to multitask.

**Education**

- Associate's Degree minimum.

**Benefits**

- Medical, dental, and vision coverage

- Paid time off

- Retirement savings options

- Wellness programs

- Other resources, based on eligibility

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## Skills

### Required
- RN licensure
- clinical experience

### Nice to have
- Appeals
- Managed Care
- Utilization Review
- computer skills
- communication skills

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/CT---Work-from-home/Appeals-Nurse-Consultant--Remote-_R1071657?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)