Clinical Review Nurse Consultant

20 hours ago


Springfield, Illinois, United States CVS Health Full time
Job Summary

CVS Health is seeking a skilled Clinical Review Nurse Consultant to join our team. As a key member of our clinical review team, you will be responsible for reviewing and evaluating clinical information and documentation to ensure compliance with regulatory and accreditation requirements.

Key Responsibilities:

  • Review and interpret clinical records and data to apply appropriate clinical criteria and policies
  • Independently coordinate clinical resolution with clinician/MD support as required
  • Act as a resource for customer service and claims processing areas

Requirements:

  • 5+ years of clinical experience
  • 2+ years of experience as a Registered Nurse with current unrestricted state licensure in state of residence
  • Preferred qualifications include utilization management review, managed care experience, and client processing experience

Benefits:

  • Competitive pay range: $66,142,576.72
  • Eligibility for a CVS Health bonus, commission, or short-term incentive program
  • Comprehensive benefits package, including medical, dental, and vision benefits
  • 401(k) retirement savings plan and Employee Stock Purchase Plan
  • Term life insurance and short-term and long-term disability benefits

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.



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