Clinical/Utilization Review Nurse

What is Aspirion?

For over two decades, Aspirion has delivered market-leading revenue cycle services. We specialize in collecting challenging payments from third-party payers, focusing on complex denials, aged accounts receivables, motor vehicle accident, workers’ compensation, Veterans Affairs, and out-of-state Medicaid.

At the core of our success is our highly valued team of over 1,400 teammates as reflected in one of our core guiding principles, “Our teammates are the foundation of our success.” United by a shared commitment to client excellence, we focus on achieving outstanding outcomes for our clients, aiming to consistently provide the highest revenue yield in the shortest possible time.

We are committed to creating a results-oriented work environment that is both challenging and rewarding, fostering flexibility, and encouraging personal and professional growth. Joining Aspirion means becoming a part of an industry leading team, where you will have the opportunity to engage with innovative technology, collaborate with a diverse and talented team, and contribute to the success of our hospital and health system partners. Aspirion maintains a strong partnership with Linden Capital Partners, serving as our trusted private equity sponsor.

What do we need?

We are seeking a compassionate and proficient Clinical Review Nurse to join our growing team of professionals. The Clinical/Utilization Review Nurse advocates for reimbursement for services provided by the hospital through their review and analysis of complex medical issues. Accountable for carrying a queue of assigned accounts. Review and analyze medical records to formulate complex clinical arguments. Support Operations and Client Management by providing feedback on medical trends, issues, and denials.

What will you provide?

• Manages complex and robust queue according to Aspirion and client needs. Queue size varies weekly.
• Reviews insurance denials, including but not limited to, medical necessity denials, patient status denials (i.e., Inpatient vs. Outpatient Observation), level of care denials (i.e., bed type), length of stay denials (including stays over a month long), readmission denials, experimental denials, clinical validation denials, and/or authorization denials.
• Reviews and utilizes clinical criteria, including but not limited to, InterQual, Milliman Care Guidelines (“MCG”), UpToDate, Medicare Policies, and State Specific Clinical Criteria.
• Drafts clinical summaries, including but not limited to, arguing against an insurance denial, confirming an insurance denial, or reviewing a clinical determination.
• When performing clinical reviews, monitors hours expended on a single account to ensure the time invested is commensurate with the account’s potential reimbursement and check in with Managing Attorney when time expended exceeds average hours for type of review
• Identifies and tracks common trends and issues for reporting to the clients.
• Collaborates with Aspirion attorneys via in person meetings, phone, and/or email.
• Attends Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and other potential meetings

Requirements

• Proficient with Word, Excel, PowerPoint, Outlook, Zoom, Microsoft Teams
• Analytical skills and the ability to make appropriate decisions independently
• Problem solver with the ability to identify issues, provide feedback and follow-up to resolution
• Work independently in a rapidly changed and growth-oriented environment with regularly changing priorities
• Prioritize assignments to complete work in a timely manner, adjusting quickly as circumstances dictate
• Efficient at handling and prioritizing multiple tasks and projects in a time-sensitive environment
• Maintains strict confidentiality of protected medical information and adherence to all HIPAA and Aspirion policies and regulations
• Must possess interest in healthcare and medical insurance claims

Education and Experience

• Requires an AS/BS in nursing.
• Minimum of one (1) year of clinical experience with an understanding of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current unrestricted RN license required.
• Preferred experience with Utilization Review, Health Insurance Denials and Appeals, Payer Audits, or Case Management.
• Familiarity with Millman and InterQual guidelines preferred.

Benefits

At Aspirion we invest in our employees by offering unlimited opportunities for advancement, a full benefits package, including health, dental, vision and life insurance upon hire, matching 401k, competitive salaries, and incentive programs.

The US base pay range for this position starts at $68,000 annually. Individual pay is determined by a number of factors including: job-related skills, experience, education, training, etc., and, where applicable, licensure or certifications obtained. Market and organizational factors are also considered. In addition to base salary a competitive benefits package is offered.

AAP/EEO Statement

Equal Opportunity Employer/Drug-Free Workplace: Aspirion is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, pregnancy, religion, national origin, ancestry, medical condition, marital status, gender identity citizenship status, veteran status, disability, or veteran status. Aspirion has a Drug-Free Workplace Policy in effect that is strictly adhered to.