Clinical Claim Review Nurse
Clinical Careers Page(27 days ago)
About this role
A Clinical Claim Review Nurse at CVS Health is a registered nurse embedded in the claims organization who brings clinical expertise to the evaluation of post-service claims and supports accurate, compliant adjudication. The role contributes to member-focused healthcare delivery and helps uphold regulatory and confidentiality standards while working within multidisciplinary teams.
Required Skills
- Clinical Review
- Medical Records
- Decision Making
- RN Licensure
- Managed Care
- Microsoft Office
- Provider Outreach
- Documentation Review
- Regulatory Compliance
Qualifications
- Associates Degree in Nursing
- Bachelor of Science in Nursing (Preferred)
- Active RN License
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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