Clinical Resolution Coordinator

5 days ago


Hartford, Connecticut, United States CVS Health Full time
About the Role

CVS Health is committed to delivering enhanced human-centric healthcare in a rapidly changing world. As an Appeals Nurse Consultant, you will be part of a team that transforms healthcare with heart. Our purpose guides our commitment to deliver services that are not only effective but also personal, convenient, and affordable.

Responsibilities:

  • Apply clinical criteria and policies to resolve member and provider issues.
  • Independently coordinate clinical resolution with internal and external clinician support as required.
  • Support various types of appeals, including UM, MPO, Coding, and Behavioral Health.

Requirements and Benefits:

To excel in this role, you should have an active and unrestricted RN licensure in your state of residence, along with at least 3 years of clinical experience. We offer a salary range of $66,575.08 - $142,576.72, plus a bonus, commission, or short-term incentive program. Our comprehensive benefits package includes medical, dental, and vision coverage, 401(k) retirement savings plan, employee stock purchase plan, term life insurance, and disability benefits.



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