[Hiring] Appeals Nurse Consultant @CVS Health

Role Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary:

• Schedule: Monday-8am-4:30pm in your time zone
• Rotation of weekend and holiday shifts, approximately 2 weekends per year, subject to change.
• 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 information
  • Researching and extrapolating pertinent clinical data
  • Applying appropriate Medicare Guidelines
  • Navigating 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.

Qualifications

• Must have active and unrestricted RN licensure in state of residence
• Excellent verbal and written communication skills
• Strong organizational skills

Requirements

• Appeals Experience
• Utilization Review
• Medicare Experience

Education

• Associate's Degree in Nursing
• Bachelor's Degree Preferred

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility

Company Description

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

The typical pay range for this role is: $54,095.00 - $142,576.00. 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.

We anticipate the application window for this opening will close on: 09/10/2026.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.