Clinical Claims Review Nurse

The Clinical Claims Review Nurse at CVS Health reviews medical claims to ensure accuracy and appropriateness of billing. This role involves analyzing clinical documentation, applying coding guidelines, and collaborating with providers to resolve discrepancies. The position is fully remote and requires an active RN license. Typical duties include reviewing claims for medical necessity, identifying potential fraud or abuse, and documenting findings. The ideal candidate has at least 2 years of clinical experience and knowledge of medical terminology and coding.