Appeals Nurse Consultant at CVS Health / Aetna

Overview

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.

Requisition Job Description Position Summary CVS Aetna is seeking a dedicated Appeals Nurse Consultant to join our remote team. In this role, you will play a critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical judgment and regulatory knowledge. Key Responsibilities Responsible for the review and resolution of clinical appeals.

Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required. This position may support UM (includes expedited), MPO, Coding, or Behavioral Health appeals.

Benefits

• for great people We 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: 09/22/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.