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CVS HealthPosted 10/21/2026full-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, applying regulatory and accreditation criteria while coordinating with clinicians. Proficient in managing multiple systems and maintaining exceptional communication in a telework environment.
Highest-signal resume keywords
Active RN LicensureClinical Appeals ExperienceUtilization Review ExperienceManaged Care Experience3+ Years Clinical Experience
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
- Coordinate clinical resolution independently with internal and external clinician support as required
- Support UM (including expedited), MPO, Coding, or Behavioral Health appeals
- Work full-time in a telework role
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 able to multitask
- Dedicated workspace free of interruptions
- Separate care arrangements for dependents during work hours
- Ability to work Monday–Friday, 8:00 AM to 5:00 PM local time
- Occasional weekend and holiday on-call coverage may be required
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 eligibility
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 ApplicationMultitasking
Soft Skills
Exceptional Communication SkillsHighly OrganizedTime Efficient
Tools & Technologies
Computer ProficiencyMultiple Systems Navigation
Certifications & Qualifications
Active RN Licensure
Industry Keywords
Clinical AppealsUtilization ManagementBehavioral Health AppealsAccreditation Requirements