Appeals Nurse Consultant at Aetna


Appeals Nurse Consultant

  • Location: United States

Job Description

This position will be working from home anywhere in the US

The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers.

Primary duties may include, but are not limited to: Requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast-paced department.

Must work independently as well as in a team environment while working remotely.

The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365 days per year.

Typical office working environment with productivity and quality expectations. Fast paced sedentary position, talking on the telephone, looking at computer screens, utilizing templates in Word, and typing on the computer.

Required Qualifications

  • 3+ years of clinical experience required
  • Registered Nurse license required
  • Weekend rotation required approximately every 9 weeks

Preferred Qualifications

  • Managed Care experience preferred
  • Utilization Management experience preferred
  • Appeals Experience
  • Coding experience preferred
  • Pre Certification experience preferred
  • Pre Authorization experience preferred


  • Associates Degree
  • Bachelors Degree Preferred

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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