Clinical Claims Review Nurse

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.

This role requires the nurse to exercise clinical judgment and perform the following duties:

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
Coordinate 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 ...