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Appeals Nurse Consultant
CVS Health. Review and resolve clinical appeals .
Posted 11/6/2026full-timeRemote • Connecticut • United StatesMid-LevelSenior💰 $54,095 - $116,760 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. Possesses strong organizational and communication skills to effectively coordinate with clinicians and manage multiple tasks.
Highest-signal resume keywords
Active RN LicensureClinical Appeals ResolutionUtilization Review ExperienceManaged Care 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 InterpretationClinical Criteria ApplicationRegulatory ComplianceMultitasking
Soft Skills
Time EfficiencyHighly Organized
Tools & Technologies
Computer ProficiencyMultiple Systems Navigation
Certifications & Qualifications
Active RN Licensure
Industry Keywords
Clinical AppealsUtilization ManagementBehavioral Health 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
- Coordinate clinical resolution independently with internal and external clinician support as required
- Support UM (including expedited), MPO, Coding, or Behavioral Health appeals
- Provide fair and accurate resolution of clinical 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
- 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