Are you a compassionate and detail-oriented healthcare professional looking for a challenging and fulfilling career opportunity? CVS Health is seeking an Appeals Nurse Consultant to join our team and help improve the lives of our members. As an Appeals Nurse Consultant, you will play a critical role in reviewing and processing appeals for denied healthcare services, ensuring that our members receive the care they need. If you have a strong clinical background, excellent communication skills, and a passion for making a difference in people's lives, we want to hear from you. Join us in our mission to provide high-quality, affordable healthcare to individuals across the nation.
- Review and process appeals for denied healthcare services in a timely and efficient manner.
- Utilize clinical knowledge and expertise to evaluate the medical necessity and appropriateness of denied services.
- Collaborate with internal and external stakeholders to gather necessary information and documentation to support appeals.
- Communicate with healthcare providers and members to obtain additional information and clarify medical records.
- Maintain accurate and organized appeal documentation, including summary of findings and outcomes.
- Adhere to company policies and procedures, as well as state and federal regulations, in the review and processing of appeals.
- Provide excellent customer service to members, healthcare providers, and internal team members throughout the appeal process.
- Participate in training and educational opportunities to stay current with industry changes and updates.
- Identify and report any trends or issues related to appeals to management.
- Continuously look for ways to improve and streamline the appeals process to ensure efficient and effective resolution for our members.
Bachelor's Degree In Nursing From An Accredited Institution
Active And Unrestricted Rn License In The State Of Employment
Minimum Of 5 Years Of Clinical Nursing Experience, Preferably In A Managed Care Or Insurance Setting
Experience With Utilization Management And Appeals Processes
Strong Communication, Critical Thinking, And Problem-Solving Skills
Communication
Time Management
Attention to detail
Medical Terminology
Case management
Problem-Solving
Medical coding
Decision-Making
Clinical Analysis
Conflict
Insurance Regulations
Utilization Review
Communication
Leadership
Time management
Interpersonal Skills
flexibility
Critical thinking
Organizational skills
Teamwork
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Appeals Nurse Consultant is $70,000-$90,000 per year. However, this can vary based on factors such as location, experience, and employer. Some appeals nurse consultants may earn higher salaries, especially those with advanced degrees and extensive experience in the field.
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CVS Health Corp. engages in the provision of health care services. It operates trough the following segments: Pharmacy Services, Retail or Long Term Care, and Corporate. The Pharmacy Services segment offers pharmacy benefit management solutions. The Retail or Long Term Care segment includes selling of prescription drugs and assortment of general merchandise. The Corporate segment involves in providing management and administrative services.

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