Back to Jobs

Appeals Nurse Consultant

Remote, USA Full-time Posted 2025-05-22

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important... as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
This is a full-time telework position.
Hours for this role are Monday-Friday 8a-5p with required rotational weekend and holiday coverage.
Position Summary
The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is considered a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include, but are not limited to: requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast paced department. Must work independently as well as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365 days per year. This position requires some weekends and holidays on a scheduled rotation.
Required Qualifications
• Active and unrestricted RN licensure in state of residence
• 3+ years of clinical experience
Preferred Qualifications
• Utilization Review experience
• Medicare experience
• Appeals experience
• Requires proficiency with computer skills including Microsoft Outlook, Windows, navigating multiple systems and keyboarding
• Time efficient and highly organized
• Exceptional verbal and written communication skills
Education
• Associate's Degree or RN diploma required
Pay Range
The typical pay range for this role is:
$61,360.00 - $132,600.00
This pay range 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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution

Apply Job!

Similar Jobs

Clinical Appeals RN

Remote, USA Full-time

Grievance and Appeals BH Nurse - Remote | WFH

Remote, USA Full-time

American Express Remote Jobs Chat Professional – mysmartpros

Remote, USA Full-time

American Express Data Entry Jobs (Live Chat, Remote) $35/Hour 2024...

Remote, USA Full-time

American Express Live Chat Support Job (Remote/Virtual) – MySmartPros

Remote, USA Full-time

Part Time American Express Jobs @privatejobspune ( Customer Care...

Remote, USA Full-time

American Express At Home (Customer Service) $20/Hr

Remote, USA Full-time

American Express Remote (No Degree) - Work From Home

Remote, USA Full-time

American Express Remote Jobs

Remote, USA Full-time

American Express Virtual Assistant Jobs $25/Hour

Remote, USA Full-time

South Airlines Call Center Rep Work From Home Jobs – Job Vacancy

Remote, USA Full-time

Want Online English Teacher (100% Remote) in Centennial, CO

Remote, USA Full-time

Life Underwriting Specialist

Remote, USA Full-time

Amazon chat Support jobs Work from home | Live Chat Jobs

Remote, USA Full-time

Total 1,245 Netflix Remote Jobs, Netflix Work From Home Jobs Salary $/25 Hour

Remote, USA Full-time

Experienced Closer in Solar Sales - Commission-Based

Remote, USA Full-time

FULL TIME Remote Delta Airline | Telecommute | Flight Benefits

Remote, USA Full-time

Inbound Call Center Sales Agent - Personal Insurance

Remote, USA Full-time

Riverside Tutors Needed – All Subjects

Remote, USA Full-time

Healthcare Data Analyst – Minneapolis (Hybrid/Remote)

Remote, USA Full-time