Experienced Appeals Nurse Consultant for Remote Medicare Appeals Processing

Transforming Healthcare with Heart: Join CVS Health as an Appeals Nurse Consultant At CVS Health, we're on a mission to redefine the healthcare experience, making it more personal, convenient, and affordable. As a leader in the healthcare industry, we're committed to delivering innovative solutions that cater to the evolving needs of our customers. With a strong presence across the United States, we're seeking a skilled and dedicated Appeals Nurse Consultant to join our team on a remote basis. About the Role As an Appeals Nurse Consultant, you will play a critical role in processing Medicare appeals for participating providers, ensuring that our decisions are guided by the latest Medicare guidelines and regulations. This is a fantastic opportunity to leverage your clinical expertise and experience in a fast-paced, dynamic environment, working independently as well as collaboratively with our team. Key Responsibilities Review and analyze clinical data to determine medical necessity for Medicare appeals Request and evaluate clinical information from providers and other relevant sources Apply Medicare guidelines and regulations to make informed decisions on appeals Navigate multiple computer system applications to access and manage relevant data Utilize templates in Word and other software tools to efficiently document and communicate decisions Maintain accurate and detailed records of appeals decisions and communications Collaborate with team members to ensure consistency and quality in appeals processing Stay up-to-date with changing Medicare regulations and guidelines to ensure compliance Essential Qualifications To succeed in this role, you will need: A minimum of 3 years of clinical experience in a relevant healthcare setting Active and unrestricted RN licensure in the state of your residence Associate's Degree or Diploma in Nursing; Bachelor's Degree preferred Strong analytical and problem-solving skills, with the ability to interpret complex clinical data Excellent communication and interpersonal skills, with the ability to effectively interact with providers and other stakeholders Proficiency in Microsoft Office and other relevant software applications Preferred Qualifications While not essential, the following qualifications will be highly regarded: Experience in Managed Care, Utilization Management, or DRG coding Previous experience in appeals processing or a related field Knowledge of Medicare regulations and guidelines Familiarity with multiple computer system applications and software tools What We Offer At CVS Health, we're committed to supporting the well-being and career growth of our colleagues. As an Appeals Nurse Consultant, you can expect: A competitive salary, with a pay range of $66,575.08 - $142,576.72, depending on your experience and qualifications Eligibility for a CVS Health bonus, commission, or short-term incentive program A comprehensive benefits package, including medical, dental, and vision coverage Opportunities to participate in our 401(k) retirement savings plan and Employee Stock Purchase Plan Access to numerous 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 Career Growth and Development As an Appeals Nurse Consultant, you'll have opportunities to grow and develop your skills in a dynamic and supportive environment. You'll be part of a talented team of healthcare professionals who are passionate about delivering high-quality care and services. With CVS Health, you'll have access to: Training and development programs to enhance your clinical and technical skills Career advancement opportunities in a growing and evolving organization A culture that values innovation, collaboration, and customer-centricity Our Culture and Work Environment At CVS Health, we're committed to creating a work environment that is inclusive, supportive, and empowering. As a remote worker, you'll be part of a distributed team that values flexibility and work-life balance. We're proud of our: Heart At Work Behaviors, which guide our commitment to delivering exceptional care and services Diverse and inclusive culture, which celebrates the unique perspectives and experiences of our colleagues State-of-the-art technology and infrastructure, which enable us to work efficiently and effectively Join Our Team If you're a motivated and experienced Appeals Nurse Consultant looking for a new challenge, we encourage you to apply for this exciting opportunity. With CVS Health, you'll be part of a team that's transforming the healthcare experience and making a positive impact on the lives of our customers. Don't miss out on this chance to join our team and shape the future of healthcare. Apply now and take the first step towards a rewarding and fulfilling career with CVS Health! Apply for this job