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CVS Health

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 fit
Core Competencies

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Demonstrates expertise in clinical appeals resolution, applying regulatory and accreditation criteria, and effectively coordinating clinical resolutions. Proficient in managing member and provider issues while maintaining exceptional communication and organizational skills.

Highest-signal resume keywords
Active RN LicensureClinical Appeals ResolutionUtilization Review ExperienceManaged Care ExperienceExceptional Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills
Clinical ExperienceData InterpretationRegulatory ComplianceClinical Criteria ApplicationMultitasking
Soft Skills
Time EfficiencyHighly Organized
Tools & Technologies
Computer ProficiencyMultiple Systems Navigation
Certifications & Qualifications
Active RN Licensure
Industry Keywords
Clinical AppealsUtilization ManagementAccreditation RequirementsBehavioral Health AppealsExpedited 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
  • 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
  • Work full-time in a telework arrangement

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
  • 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
  • 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, based on eligibility