Clinical Claims Review Nurse
About the role
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.
Responsibilities
- Review and interpret clinical documentation obtained from medical records or systems.
- Apply clinical decision-making to utilize appropriate clinical criteria and policies for post-service claims.
- Coincide clinical resolutions independently, with clinician/MD support as required.
- Act as a resource for customer service and claims processing teams.
- Train new staff and provide cross-training to existing team members.
- Identify trends and provide feedback to leadership if discrepancies or potential fraudulent activities are identified.
Requirements
- Nursing degree (RN)
- A minimum of 2–3 years of professional experience as a licensed Registered Nurse (RN), or equivalent clinical experience
- Strong analytical skills to assess medical claims
Qualifications
Required Qualifications:
- Nursing degree (RN)
- A minimum of 2–3 years of professional experience as a licensed Registered Nurse (RN), or equivalent clinical experience
- Strong analytical skills to assess medical claims
Skills
Not specified
Benefits
The typical pay range for this role is $26.01 - $68.55. 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.
Pay
The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
Schedule
Anticipated Weekly Hours: 40
Pay Range
The Typical Pay Range For This Role Is $26.01 - $68.55