[Hiring] Appeals Nurse Consultant @CVS Health

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description CVS Aetna is seeking a dedicated Appeals Nurse Consultant to join our remote team. In this role, you will be responsible for processing the medical necessity of Medicare appeals for participating providers. • Requesting clinical, researching, and extrapolating pertinent clinical information • Applying appropriate Medicare Guidelines • Navigating through multiple computer system applications in a fast-paced department • Working independently as well as in a team environment while working remotely • Reviewing and resolving clinical appeals • Interpreting data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for provider issues This is a full-time telework position with standard hours of Monday–Friday, 8:00 AM to 5:00 PM (local time). No weekends or holidays required. 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. Qualifications • Must have active and unrestricted RN licensure in state of residence • 3+ years clinical experience Requirements • Appeals, Managed Care, or Utilization Review experience preferred • Pre Certification or Pre Authorization experience preferred • Proficiency with computer skills including navigating multiple systems • Exceptional communication skills • Time efficient, highly organized, and ability to multitask Education • Associates Degree minimum OR Diploma RN required • Bachelors Degree preferred Benefits • Affordable medical plan options • 401(k) plan (including matching company contributions) • 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 Apply tot his job