Appeals Nurse Consultant - MUST LIVE IN Louisiana
Clinical Careers Page(18 hours ago)
About this role
This clinical review role involves investigating and resolving appeals, complaints, and grievances related to health benefits, employing clinical expertise, and ensuring compliance with regulations. It requires collaboration across various stakeholders to facilitate a thorough and timely resolution process.
Required Skills
- Clinical Documentation
- Appeals Resolution
- Regulatory Compliance
- Clinical Review
- Customer Service
- Benefit Language
- Data Gathering
- Code Logic
- Clinical Policies
- Healthcare Regulations
Qualifications
- RN with current unrestricted state licensure
About Clinical Careers Page
cvshealth.comCVS Health is America's leading health solutions company, providing integrated services across retail pharmacy (CVS Pharmacy), pharmacy benefits management (CVS Caremark), and health insurance (Aetna). The company offers pharmacy services, health plans, clinical care (including MinuteClinic), and health-and-wellness programs for consumers, employers, and government payers. By combining a large national retail footprint with claims processing, care management, and clinical services, CVS Health aims to coordinate care, lower costs, and improve health outcomes. Businesses and consumers use its solutions for medication management, plan administration, and in-person and virtual care.
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