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Appeals Nurse Consultant
CVS Health. Review and resolve clinical appeals .
Posted 11/6/2026full-timeRemote • Connecticut • United StatesMid-LevelSenior💰 $66,575 - $142,576 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical appeals resolution and utilization management, with a strong focus on regulatory compliance and effective communication. Proficient in interpreting clinical data and coordinating resolutions with internal and external stakeholders.
Highest-signal resume keywords
Active RN LicensureClinical Appeals ResolutionUtilization Management Experience3+ Years Clinical ExperienceExceptional Communication Skills
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 InterpretationRegulatory ComplianceClinical Criteria ApplicationMultitaskingTime Management
Soft Skills
Highly OrganizedEffective CommunicationProblem-Solving
Tools & Technologies
Computer ProficiencyMultiple Systems Navigation
Certifications & Qualifications
Active RN Licensure
Industry Keywords
Managed CareUtilization ReviewClinical AppealsAccreditation 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
- Coordinate clinical resolution independently with internal and external clinician support as required
- Support UM, including expedited appeals, MPO, Coding, or Behavioral Health appeals
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 preferred
- Proficiency with computer skills including navigating multiple systems preferred
- Exceptional communication skills preferred
- Time efficient, highly organized, and ability to multitask preferred
- Dedicated workspace free of interruptions
- Dependents must have separate care arrangements during work hours
- Availability for standard Monday–Friday, 8:00 AM to 5:00 PM local time
- Occasional weekend and holiday on-call coverage may be required
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being