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CVS HealthPosted 10/21/2026full-timeRemote • Massachusetts • 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 clinical criteria and policies in compliance with regulatory standards. Proficient in managing clinical documentation and coordinating resolutions with clinicians while maintaining exceptional organizational and communication skills.
Highest-signal resume keywords
Active RN LicensureClinical Appeals ResolutionUtilization Review Experience3+ Years Clinical ExperienceExceptional Communication Skills
About the role
Key responsibilities & impact- Review and resolve clinical appeals
- Review documentation and interpret clinical-record data
- Apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements
- Coordinate clinical resolutions independently with internal and external clinician support as required
- Support UM, MPO, Coding, or Behavioral Health appeals
- Work full-time telework hours Monday–Friday, 8:00 AM to 5:00 PM local time
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 able to multitask preferred
- Dedicated workspace free of interruptions
- Separate care arrangements for dependents during work hours
- Availability for standard Monday–Friday, 8:00 AM to 5:00 PM local-time hours
- 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 in addition to base pay
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 Record Data InterpretationClinical Criteria ApplicationManaged Care ExperienceAppeals ManagementDocumentation Review
Soft Skills
Highly OrganizedTime EfficientMultitasking Ability
Tools & Technologies
Computer ProficiencyMultiple Systems Navigation
Certifications & Qualifications
Active RN Licensure
Industry Keywords
Regulatory ComplianceAccreditation RequirementsBehavioral Health AppealsUtilization Management