Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

This is a full-time telework position.

The schedule for this position is Monday-Friday with on call requirement every five weeks.

Has oversight of appeals (clinical and nonclinical staff), serves as expert and mentor for problem solving and critical thinking, develops, initiates, monitors and communicates performance expectations and implements performance actions when necessary, participates in recruitment and hiring processes for staff, accountable for maintaining compliance with policies and procedure and implements them at the employee level, supports team and individual development, monitors open inventory and production, monitors staff clinical development, production and quality, and may have oversight to the expedited appeals process from intake to resolution. Plans and sets day to day objectives and priorities for the team and delivers results that have direct impact on the achievement of results within the job area. May support UM, MPO, or Coding appeals. May have weekend on-call requirements.

Required Qualifications

• Active and unrestricted RN licensure in state of residence
• 3+ years clinical experience
• 2+ years appeals experience

Preferred Qualifications

• Computer literacy and experience familiarity with Microsoft Excel, Word, and web-based applications desired
• Ability to work with people in such a manner as to build high morale and group commitment to goals and objectives
• Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes
• Ability to communicate effectively with Providers, Members, Staff and other Leaders both in oral and written formats

Educational Requirements

• RN Associate's Degree minimum required. BSN preferred

Pay Range

The typical pay range for this role is:

$80,340.00 - $173,040.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/27/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.