Appeals Nurse Consultant

CVS Aetna is hiring an Appeals Nurse Consultant for its remote team. You will review and resolve clinical appeals, applying sound clinical judgment, regulatory knowledge, and accreditation requirements to member and provider issues. Responsibilities include reviewing clinical documentation, interpreting data from clinical records, and applying appropriate clinical criteria and policies. You will independently coordinate clinical resolution, engaging internal or external clinician support as needed. This position may support Utilization Management (including expedited), MPO, Coding, or Behavioral Health appeals.

Schedule is Monday–Friday, 8:00 AM–5:00 PM local time, with occasional weekend and holiday on-call coverage. This is a 100% remote role; a dedicated, interruption-free workspace is required, and dependents must have separate care arrangements during work hours.

Required: active, unrestricted RN license in state of residence; 3+ years clinical experience; Associate's degree minimum. Preferred: prior appeals, managed care, or UR experience; strong multi-system computer proficiency; excellent communication and organizational skills.

Pay range: $60,522–$129,615 base, plus eligibility for CVS Health bonus or short-term incentive program. Comprehensive benefits including medical, dental, vision, PTO, and retirement savings.