Remote Appeals Nurse Consultant: Clinical Resolution
CVS Health Corporation
- Remote job
CVS Health Corporation's CVS Aetna unit is seeking a dedicated Appeals Nurse Consultant to join our remote team. This full-time role offers a 40-hour workweek and remote flexibility, with occasional on-call coverage to support clinical appeals. Requirements include an active and unrestricted RN license in the resident state and at least 3 years of clinical experience. The role focuses on reviewing documentation, applying clinical criteria, and coordinating with clinicians to resolve member and #J-18808-Ljbffr CVS Health Corporation
$66.58k - $142.58k
...community at a time. Position Summary CVS Aetna is seeking a dedicated Appeals Nurse Consultant to join our remote team. Key Responsibilities Responsible for the review and resolution of clinical appeals. Reviews documentation and interprets data obtained from clinical...Remote workHourly payWeekly payFull timeTemporary workWork experience placementLocal areaMonday to FridayShift work- ...variety of sources. The Clinical Resources is... ...position provides clinical consultation, technical assistance,... ...Conditions of Employment & Appeal Rights Residency... ...: C7E1XX Nurse Consultant Minimum... ...facilitating in-person and remote trainings for medical...Remote workTemporary workPart timeWork experience placementImmediate startFlexible hoursNight shift
- CVS Health is seeking an Appeals Nurse Consultant to process Medicare Part C appeal requests from members and providers. The role is production-based and remote, with a 40-hour work week and occasional weekend/holiday rotations. Qualified candidates hold an RN license,...Remote job
- CVS Health is recruiting an Appeals Nurse Consultant to process medical necessity for Medicare Part C appeals. The role combines independent and team work in a remote setting, with a 40-hour weekly schedule and occasional weekend/holiday rotations. Required RN licensure...Remote job
- CVS Health in the United States is seeking an Appeals Nurse Consultant to evaluate Medicare Part C medical necessity for members and providers.... ...role blends independent action with team collaboration in a remote setting. The position features a 40-hour work week, weekend...Remote jobWeekend work
- CVS Health is seeking an Appeals Nurse Consultant to process Medicare Part C appeals. The role is full-time (40 hours/week... ...of weekends/holidays. The position supports a remote, team-driven environment in a fast-paced clinic setting. Qualified applicants must hold an...Remote jobFull timeShift workWeekend work
- CVS Health is seeking an Appeals Nurse Consultant to review and determine medical necessity for Medicare Part C appeals from members and providers... ...communication, and the ability to work independently in a remote, fast-paced environment. Typical schedule includes 40 hours...Remote jobWeekend work
- CVS Health in Idaho is seeking an Appeals Nurse Consultant to process the medical necessity of Medicare Part C appeals. This full-time role requires... ...team focused on safe, quality care. The role supports remote work within the U.S. time zones. #J-18808-Ljbffr CVS HealthRemote jobFull timeWeekend work
- Piper Companies is seeking a Clinical Appeals Nurse for a fully remote healthcare-based opportunity. This Clinical Appeals Nurse position is a long-term contract role focused on clinical review, appeal resolution, regulatory compliance, and member/provider support within...Remote jobLong term contract
- Tampa General Hospital is seeking a Claims Resolution Specialist I to ensure timely submission... ...requires analyzing trends, handling appeals, and adhering to payer guidelines and regulations... .... The position is part-time with hybrid remote eligibility in the Tampa area. Qualified...Remote jobPart time
- ...Management / Public Assistance Consultants to our Disaster Recovery... ...deployments and may be performed remotely, onsite at client locations,... ...service and facilitate resolution of project-related issues and... ...Determination Memoranda responses, appeals, arbitration requests, and...Remote workContract workTemporary workFor contractorsWork at officeLocal areaWorldwideAfternoon shift
- ...PA requirement checks, denial codes, retro PA, and overturned appeal flows. 9. Admit Date Payer Responsibility (Inpatient Stays) MA... ...Payment of Z codes with no associated C, D, or R code). Issue-Resolution Leadership and SME Support. Support the following: 1. Complete...Remote workDaily paidContract workShift work
$82k - $124k
...Specialist This is a fully remote role based in the... ...and provide resolutions to non-clinical treatment issues for... ...Proactively and effectively consult with and engage the... ...specialists for denial/appeal support Trigger... ...e.g. contact center, nursing, social service support...Remote workHourly payTemporary workWork at officeImmediate startFlexible hours$21.68 - $31.08 per hour
...Work Location: This is a fully remote, permanent work-from-home... ...performed by the administrative and clinical team. Provide administrative... ...with potential solutions for resolution. Some knowledge of/prior use... ...of general practices for appeals, complaints, and grievances handling...Remote workHourly payPermanent employmentSecond jobWork at officeWork from homeWeekend work- Chief Nursing & Clinical Education Officer Join to apply for the Chief Nursing and Clinical Education Officer role at Evidence In Motion (EIM... ...maternity benefits and much more Key Responsibilities This is a remote position. Strategic Leadership Set and execute the vision...Remote work
- ...Job Description Senior Patent Advisor (Remote) ID: ARS-OTT-003 Location: Washington... ...responses to office actions, petitions, appeals, and other forms of response required to... ...or furnishes facts to Agency staff for resolution of the matter. 10% Completes special...Remote workFull timeTemporary workPart timeWork at office
- ...Clinical Appeals Specialist The Clinical Appeals Specialist completes research, basic analysis... ...and prioritize appeal requests using nursing expert knowledge and all available clinical... ...Manager Upon Hire Pref LNCC - Legal Nurse Consultant Certified Upon Hire Pref...Remote workWork at office
- ...Grievance & Appeals Coordinator Are you a detail-oriented managed care professional looking for an exciting work-from-home opportunity... ...authorization and claims concerns, and provide clear written resolutions to ensure high satisfaction for both members and providers....Remote workWork from home
$54.1k - $142.58k
...CVS Health Nurse Appeal Consultant We're building a world of health around every individual shaping... ..., but are not limited to: requesting clinical, research, extrapolating pertinent... ...as in a team environment while working remotely. The Medicare Clinical Appeals Team C...Remote workFull timeLocal areaShift workWeekend work- ...unified transformation. About the Role: Remote- USA, India -Virtual Contact Center and... ...(Advocacy) and claims processing and resolution (Claims Operations). This blended role... ...Investigate and resolve claim denials, appeals, discrepancies, overpayments, and billing...Remote workWork at office
- ...5 days/week, 8 hours/day (no remote/hybrid). Ability to work under... ...acocunts, and unbilled claim resolution. Verify eligibility,... ...reports and preparing data for appeals, such as pulling medical records... ...continuity. Collaborate with clinical staff to gather documentation...Remote workDaily paidLocal areaFlexible hours
$65k - $116.75k
R1 RCM is seeking a Clinical Coding Appeals Nurse for a remote, US-based role. You will review medical records, draft appeals, and provide coding recommendations using ICD-9/10 CM/PCS, CPT, HCPCS, and NCCI guidance. Strong nursing background and coding certifications are...Remote job- R1 RCM is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals for denied or underpaid claims. You will apply clinical... .... Strong MS Office skills are essential for this remote role. The position requires a Nursing degree with 5 years...Remote job
- R1 RCM Inc. is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals for denied and underpaid claims. The role focuses... ...inpatient experience and coding certifications. This remote, independent position offers a target bonus and competitive...Remote job
- ...Job Description Description: Job Title: Appeals Nurse Manager Company: Physician Care Coordination Consultants (PC3) Location: Remote Job Type: Full-time Job... ...providing leadership and oversight of the clinical appeals function, ensuring that denied medical...Remote workFull timeWork at office
- ...liability claims team is currently seeking a Sr. Consultant Specialized Claims to join our growing team. This position can be fully remote or hybrid at one of claims office... ...strategies including discovery, trial, and resolution planning.Represent the company at trials,...Remote workFull timeTemporary workWork at officeWork from home
$80k - $200k
...communities.The RoleVeeva Vault Clinical Data Management System (CDMS... ...is looking for Senior Consultants who have life sciences software... ...based listings. This is a remote, full-time permanent role with... ...of all feedback, resolution of issues, and acceptance of...Remote workPermanent employmentFull timeWork at officeLocal areaWork from home3 days per week$108k - $200k
...extraordinary care.This role is available for full remote work.#LI-LP1#LI-REMOTEJob Description... ...more about you! As a Life Underwriting Consultant, you'll analyze, select and classify... ...direction. Proficiency in conflict resolution. Agile and adaptable. Advanced ability to...Remote workFull timeContract workTemporary workPart timeCasual workWork at officeWork from homeHome officeFlexible hours- ...design, build, and test phases sometimes remotely and other times at the client site as... ...Handle support cases from notification to resolution and validation. Participate in the... ...acceptable. But need to support EST hours. Posting Date:Department:IT Consulting - 1111910011Remote work
- ...categorizing issues and coordinating with technical teams for timely resolution.PROTOCOL ANALYSIS: Performs moderately complex protocol... ...COMMUNICATION: Partners with vendors, third party service providers, remote technology teams, and internal teams to execute onsite...Remote workWork experience placement
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Appeals Nurse Consultant: Clinical Resolution. Be the first to apply!
- database consultant Hartford, CT
- work from home nurse consultant Hartford, CT
- fitness consultant Hartford, CT
- global consultant Hartford, CT
- temporary consultant Hartford, CT
- workplace consultant Hartford, CT
- program consultant Hartford, CT
- banking consultant Hartford, CT
- forensic consultant Hartford, CT
- network consultant Hartford, CT



