[Hiring] Member/Non-Par Provider 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.

Schedule: Thursday-Sunday 10 hour shifts

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 Thursday, Friday, and every weekend 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 physical, emotional, and financial well-being
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility

Pay Range

The typical pay range for this role is: $66,575.00 - $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.

Application Information

We anticipate the application window for this opening will close on: 07/31/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.