Clinical Review Nurse - Remote
Location: Fort Worth
Posted on: May 16, 2022
Aspirion's Clinical 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
DUTIES AND RESPONSIBILIITES:
Manages complex and robust queue according to Aspirion and client
needs. Queue size varies weekly.
Conducts weekly reviews and responsible for escalating foreseeable
Complies with timely filing deadlines as provided by Aspirion
Assists with short-notice timely filing deadlines.
Reviews extensive, high dollar claims and collaborate with
Management in addressing the medical components of said claims.
Reviews medical records and documentation pertaining to Aspirion
account work within Aspirion Shared Drives or directly in Client
Participates in required Client System trainings.
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
Identifies and tracks common trends and issues for reporting to the
Provides feedback regarding common trends and issues.
Contributes to Quarterly Nurse Feedback Memorandum, Issues and
Recommendations Reports, and other potential projects.
Collaborates with Aspirion attorneys via in person meetings, phone,
Answers questions pertaining to clinical analysis of accounts.
Advises Aspirion attorneys and employees about clinical
Compiles training material and educational sessions associated with
clinically related topics and present such educational materials to
Attends Clinical Team Meetings, All Company Meetings, Education
Opportunities, Trainings, and other potential meetings.
Participates in Monthly Chat Sessions.
Appropriately utilizes and updates Aspirion's eCollections
Awareness of and adherence to Aspirion policy and procedures.
Adheres to HIPAA compliance rules and regulations.
Responsible for reporting any violations relating to company policy
Responsible for escalating IT issues to Managing Attorney.
Performs additional duties as assigned.
EDUCATION AND EXPERIENCE QUALIFICATIONS:
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
Current unrestricted RN or LPN license required.
Experience in an acute hospital utilization review and/or case
management is required.
Previous experience appealing clinical denials for
Familiarity with Millman and InterQual guidelines preferred.
Proficient in Microsoft Word, Excel, and other desktop
Aspirion offers a competitive benefit package and workplace perks.
Please inquire during the interview process.
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
Keywords: Aspirion, Fort Worth , Clinical Review Nurse - Remote, Healthcare , Fort Worth, Texas
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