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Appeals Nurse Consultant
CVS Health Careers. Review and resolve clinical appeals .
Posted 11/7/2026full-timeRemote • West Virginia • United StatesMid-LevelSenior💰 $54,095 - $116,760 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical appeals resolution, applying regulatory and accreditation criteria while effectively coordinating with clinicians. Strong communication and organizational skills are essential for managing multiple tasks and addressing member and provider issues.
Highest-signal resume keywords
Active RN LicensureClinical Appeals ExperienceUtilization Review ExperienceManaged Care Experience3+ Years Clinical Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Documentation ReviewData InterpretationClinical Criteria ApplicationRegulatory ComplianceMultitasking
Soft Skills
Exceptional Communication SkillsHighly OrganizedTime Efficient
Tools & Technologies
Computer ProficiencyMultiple Systems Navigation
Certifications & Qualifications
Active RN Licensure
Industry Keywords
Clinical AppealsUtilization ManagementManaged CareAccreditation Requirements
About the role
Key responsibilities & impact- Review and resolve clinical appeals
- Review documentation and interpret data from clinical records
- Apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements
- Address member and provider issues
- Independently coordinate clinical resolution with internal and external clinician support as required
- Support UM (including expedited), MPO, Coding, or Behavioral Health appeals
- Work Monday–Friday, 8:00 AM to 5:00 PM local time
- Provide occasional weekend and holiday on-call coverage as required
Requirements
What you’ll need- Active and unrestricted RN licensure in state of residence
- 3+ years clinical experience
- Associate's Degree minimum
- 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
- Dedicated workspace free of interruptions
- Dependents must have separate care arrangements during work hours
Benefits
Comp & perks- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program in addition to base pay