Job Description

Clinical Nurse Specialist

At Aspirion, our mission is simple and meaningful: to help healthcare providers get paid accurately, quickly, and transparently for the care they deliver. By combining deep human expertise with advanced technology and AI, we are helping make healthcare more affordable and accessible for everyone.

For more than two decades, Aspirion has been a market leader in revenue cycle services, specializing in some of the most complex and high impact areas of reimbursement. From challenging denials and zero balance reviews to aged accounts receivable, motor vehicle accident claims, workers' compensation, Veterans Affairs, and out of state Medicaid, we take on the work that others cannot solve and deliver real results for our clients. At the heart of that success is our team. Our teammates are the foundation of everything we do. With more than 1,400 individuals across the organization, we are united by a shared commitment to delivering exceptional outcomes and creating meaningful impact for the hospitals and health systems we serve.

We are building a results driven environment where high performance, collaboration, and continuous growth are expected and supported. The people who thrive here bring a growth mindset, stay open to new technology, and collaborate across teams to solve problems. You will have the opportunity to work alongside a talented and driven team, engage with innovative technology, and play a direct role in solving complex challenges that matter.

Joining Aspirion means more than taking a job. It means being part of a team that is shaping the future of healthcare operations while making a measurable difference for providers and patients alike.

Impact You Will Make

The Clinical Nurse Specialist plays a critical role in resolving complex clinical denials by translating medical documentation into clear, evidence-based appeal arguments that drive reimbursement outcomes. This role directly supports revenue recovery, reduces write-offs, and improves payer performance.

By analyzing denial trends and identifying root causes, this position contributes to denial prevention strategies and continuous improvement across the revenue cycle. The Clinical Nurse Specialist also serves as a clinical resource, helping strengthen team capability and ensuring high-quality clinical review standards.

What You Will Do

• 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

What You Will Bring

• 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
• Active LPN or RN license (required)

What We Would Like To See

• 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

Core Expectations

• Demonstrate integrity and ethics in day-to-day tasks and decision making, operate effectively in the environment and the environment of the work group, maintain a focus on self-development and seek out continuous feedback and learning opportunities
• Support Compliance Program by adhering to policies and procedures pertaining to HIPAA, GLBA, FCRA, and other laws applicable to business practices; this includes becoming familiar with Code of Ethics, attending training as required, notifying management when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations
• US remote-based colleagues are not permitted to work from a location outside of the United States, at any time, without prior, written approval.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Aspirion is an Equal Opportunity Employer and does not discriminate on the basis of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, gender identity, military veteran status, or any other characteristic protected by law

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