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Appeals Nurse Consultant
CVS Health. Review and resolve clinical appeals .
Posted 9/16/2026full-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 fast-paced environment.
Highest-signal resume keywords
Active RN LicensureClinical ExperienceAppeals ExperienceUtilization Review 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 Appeals ResolutionData InterpretationRegulatory ComplianceClinical Criteria ApplicationManaged Care Knowledge
Soft Skills
Time ManagementOrganizational SkillsMultitasking Ability
Tools & Technologies
Computer ProficiencyMultiple Systems Navigation
Certifications & Qualifications
Active RN Licensure
Industry Keywords
Clinical RecordsUtilization ManagementBehavioral Health Appeals
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
- Independently coordinate clinical resolution with internal and external clinician support
- Support UM, 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 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
- 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