Position SummarySchedule:
- 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, research, extrapolating pertinent clinical, 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.
Required QualificationsMust have active and unrestricted RN licensure in state of residence
Excellent verbal and written communication skills.
Strong organizational skills
Preferred QualificationsAppeals Experience, Utilization Review, Medicare Experience
EducationAssociate's Degree in Nursing
Bachelor's Degree Preferred
Anticipated Weekly Hours40
Time TypeFull time
Pay RangeThe 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.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 09/10/2026
