Revenue Cycle Management Services | Advanced Technology, Top Talent, Optimal Revenue Results
Clinical Nurse Specialist
Location
Florida
Posted
4 hours ago
Salary
$68K - $100K / year
Seniority
Junior
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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