Clinical Claim 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.

As a Clinical Claim Review Nurse you will be responsible for the review and evaluation of clinical information and documentation. 
Reviews documentation and interprets data obtained from clinical records or systems and uses clinical decision making to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider claims. 
Independently coordinates the clinical resolution with clinician/MD support as required. 
Considers all documentation provided including medical re...