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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Appeals Nurse Consultant

Primary Location: Hartford, Connecticut
Additional Locations: CT-Hartford
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POSITION SUMMARY
Review clinical appeals related to Medicare Advantage Plan members using Centers for Medicare Service criteria as well as other criteria

Fundamental Components:
Review clinical appeals concerning a variety of clinical areas
Make recommendations to Medical Directors
Consult with Medicare coverage guidelines, Clinical Policy Bulletins and Milliman Care Guidelines

BACKGROUND/EXPERIENCE:
Managed Care experience preferred
3+ years of clinical experience required

EDUCATION
The highest level of education for candidates in this position is a Associate's degree or equivalent experience.

LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required


FUNCTIONAL EXPERIENCES
Functional - Nursing/Concurrent Review/discharge planning/3+ Years
Functional - Nursing/Clinical claim review and coding/1+ Years
Functional - Nursing/Medical-Surgical Care/3+ Years


REQUIRED SKILLS
Service/Creating a Differentiated Service Experience/FOUNDATION
Technology/Leveraging Technology/FOUNDATION


DESIRED SKILLS
Leadership/Driving a Culture of Compliance/FOUNDATION


ADDITIONAL JOB INFORMATION
A unique opportunity for a registered nurse to work with a great group of nurses.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.





Benefit eligibility may vary by position. Click here to review the benefits associated with this position.



Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)

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