Consultant

• 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
• Independently coordinate clinical resolution with internal and external clinician support as required
• Support UM (including expedited), 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

Explore Appeals Nurse Consultant at CVS Health Careers. Review requirements and application details.