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Aspirion

Revenue Cycle Management Services | Advanced Technology, Top Talent, Optimal Revenue Results

Clinical Nurse Specialist

GeneralGeneralFull TimeRemoteJuniorTeam 1,001-5,000Since 2006H1B No SponsorCompany SiteLinkedIn

Location

Florida

Posted

4 hours ago

Salary

$68K - $100K / year

Seniority

Junior

Professional Certificate1 yr expEnglish

Job Description

Clinical Nurse Specialist

Aspirion

• Review and analyze medical records and denial rationale to develop clinically supported appeal arguments • Interpret and apply clinical guidelines (e.g., InterQual, Milliman) to support medical necessity determinations • Prepare, edit, and enhance appeals using internal tools (e.g., DOCIQ) • Accurately assign denial root causes and complete nurse review reporting • Identify denial trends and escalate insights to support prevention strategies and process improvement • Document all case activity clearly within internal and client systems • Participate in quality control reviews and provide feedback to improve appeal effectiveness • Serve as a clinical subject matter expert for team members and cross-functional partners • Support onboarding, training, and ongoing education for clinical staff • Collaborate with operations and leadership to meet client expectations and performance goals • Maintain productivity and quality standards in a metrics-driven environment

Job Requirements

  • Active LPN or RN license (required)
  • 1+ year experience in utilization review, case management, or clinical denials
  • 1+ year experience resolving hospital clinical denials
  • Acute care clinical experience preferred
  • Certification in Case Management or Utilization Review preferred
  • Strong clinical reasoning and critical thinking skills
  • Ability to interpret medical documentation and payer guidelines
  • Knowledge of utilization management and medical necessity criteria (e.g., InterQual, Milliman)
  • Strong written communication skills for persuasive clinical appeals
  • Attention to detail with ability to manage multiple priorities
  • Proficiency with EMRs and healthcare systems
  • Ability to work independently and collaboratively in a fast-paced environment

Benefits

  • Not specified

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