Clinical Nurse Specialist

Aspirion

Clinical Nurse Specialist analyzing medical records to develop appeal arguments for healthcare providers. Aiding in revenue recovery and improving payer performance through denial resolution strategies.

Posted 6/26/2026full-timeRemote • Florida • 🇺🇸 United StatesJunior💰 $68,000 - $100,000 per yearWebsite

About the role

Key responsibilities & impact

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
Collaborate with operations and leadership to meet client expectations and performance goals

Requirements

What you’ll need

Active LPN or RN license (required)
1+ year experience in utilization review, case management, or clinical denials
1+ year experience resolving hospital clinical denials
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.

Benefits

Comp & perks

Health insurance
401(k) matching
Flexible working hours
Paid time off
Professional development opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

utilization reviewcase managementclinical denialsclinical reasoningcritical thinkingmedical documentation interpretationpayer guidelines interpretationutilization managementmedical necessity criteriaEMR proficiency

Soft Skills

strong written communicationattention to detailability to manage multiple priorities

Certifications

LPN licenseRN license