Clinical Claims Review Nurse
$26.01 - $68.55 per hourCVS Health Corporation
About This Role
The Clinical Claims Review Nurse at CVS Health is responsible for reviewing and interpreting clinical documentation, applying clinical decision-making for post-service claims, and coordinating clinical resolutions. This role is ideal for experienced nurses with strong analytical skills who are looking to contribute to a more connected and compassionate health experience.
Highlights
- Pay: $26.01 - $68.55/hour
- Location: Remote, ND
- Schedule: Full-time
What You'll Do
- Review and interpret clinical documentation 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 compliance.
Requirements
Education
- Nursing degree (RN) required
- Bachelor’s degree preferred
Experience
- 2–3 years of professional experience as a licensed Registered Nurse (RN) or equivalent clinical experience
Licenses & Certifications
- Current and unrestricted Registered Nurse licensure in state of residence required
Benefits
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs and other resources
About CVS Health
CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They prioritize safety and quality in everything they do, fostering a workplace where every colleague feels valued and belongs.
#J-18808-LjbffrVacancy posted 6 hours ago
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