Clinical Claims Review Nurse

Responsibilities Review and interpret clinical documentation obtained from medical records or systems. Apply clinical decision-making to utilize appropriate clinical criteria and policies for post-service claims. Coordinate clinical resolutions independently, with clinician/MD support as required. Act as a resource for customer service and claims processing teams. Train new staff and provide cross-training to existing team members. Identify trends and provide feedback to leadership if discrepancies or potential fraudulent activities are identified. Remain current with applicable laws, regulations, and internal workflows to ensure full compliance with organizational and state-specific requirements. Qualifications Nursing degree (RN). A minimum of 2-3 years of professional experience as a licensed Registered Nurse (RN), or equivalent clinical experience. Strong analytical skills to assess medical claims. Anticipated Weekly Hours 40 Time Type Full time Pay Range $26.01 - $68.55 The typical pay range for this role represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Benefits This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. Application Information We anticipate the application window for this opening will close on: 07/08/2026 Equal Employment Opportunity Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement