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CVS Health Appeals Nurse Consultant in Kansas

Job Description

This position will be working from home and is open to anywhere in the USThe Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and 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. The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365 days per year.

Required Qualifications

3+ years of clinical experience required Registered Nurse with current and unrestricted license required

Preferred Qualifications

Utilization ManagementCare ManagementMedicare Aetna Appeals experienceComplaint & Appeals Experience

Education

RN license

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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