Appeals Nurse Consultant (Remote)

Position Summary CVS Aetna is seeking a dedicated Appeals Nurse Consultant to join our remote team. In this role, you will play a critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical judgment and regulatory knowledge. Key Responsibilities Review and resolve clinical appeals. Examine documentation and interpret data from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues. Coordinate the clinical resolution with internal or external clinician support as required. Support Utilization Management (including expedited), MPO, coding, or behavioral health appeals. Work full‑time telework hours Monday‑Friday, 8:00 AM to 5:00 PM (local time); occasional weekend or holiday on‑call coverage may be required. Remote Work Expectations This is a 100% remote role; candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required Qualifications Active and unrestricted RN licensure in the state of residence. 3+ years of clinical experience. Associate’s Degree minimum. Preferred Qualifications Appeals, managed care, or utilization review experience. Proficiency with computer skills, including navigating multiple systems. Exceptional communication skills. Time‑efficient, highly organized, and able to multitask. Anticipated Weekly Hours 40 hours per week. Pay Range The typical pay range for this role is $60,522.00 – $129,615.00. This represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. Additional incentive programs such as bonus, commission, or short‑term incentive may also apply. Benefits Eligible for a comprehensive benefits package, including medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and additional resources based on eligibility. EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. #J-18808-Ljbffr