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Appeals Nurse Consultant
Lifelancer. Review and resolve clinical appeals .
Posted 9/23/2026full-timeRemote • Connecticut • United StatesMid-LevelSenior💰 $66,575 - $142,576 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical appeals resolution, applying clinical criteria and policies in compliance with regulatory standards. Proficient in managing member and provider issues while coordinating clinical resolutions effectively.
Highest-signal resume keywords
Active RN LicensureClinical Appeals ResolutionUtilization Review ExperienceExceptional Communication Skills3+ Years Clinical Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Documentation ReviewData InterpretationRegulatory ComplianceManaged Care KnowledgeUtilization Management Support
Soft Skills
Time ManagementOrganizational SkillsMultitasking Ability
Tools & Technologies
Computer ProficiencyMultiple Systems Navigation
Certifications & Qualifications
Active RN Licensure
Industry Keywords
Clinical AppealsAccreditation RequirementsBehavioral Health AppealsExpedited AppealsMPO
About the role
Key responsibilities & impact- Review and resolve clinical appeals
- Review documentation and interpret data from clinical records
- Apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements
- Address member and provider issues
- Independently coordinate clinical resolution with internal and external clinician support as required
- Support UM, including expedited appeals, MPO, Coding, or Behavioral Health appeals
- Work standard Monday–Friday hours, 8:00 AM to 5:00 PM local time
Requirements
What you’ll need- Active and unrestricted RN licensure in state of residence
- 3+ years clinical experience
- Associate's Degree minimum
- Appeals, Managed Care, or Utilization Review experience preferred
- Proficiency with computer skills including navigating multiple systems
- Exceptional communication skills
- Time efficient, highly organized, and able to multitask
- Dedicated workspace free of interruptions
- Separate care arrangements for dependents during work hours
- Availability for occasional weekend and holiday on-call coverage may be required
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility