Lead Legal Nurse

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Assess liability demand packages, including medical documentation, billing details, and treatment timelines to pinpoint gaps, inconsistencies, and cost factors.

• Apply evidence-based guidelines (ODG, MCG, InterQual, etc.) to decide between authorization and escalation to Peer or Physician Review.

• Analyze historical and anticipated costs associated with medical treatment.

• Accurately document in Rising’s systems (and client systems as necessary) and produce a demand package review report.

• Compose clear, concise, and defensible nurse summaries for all UR and demand review files.

• Build and maintain collaborative relationships with clients, attorneys, and internal stakeholders.

⛳️ Requirements

• An Associate or Bachelor’s Degree in nursing.

• An active RN license in one or more states.

• Experience in drafting and/or reviewing liability demand packages or supporting claim litigation/negotiation is strongly preferred.

• A minimum of 5 years of clinical, legal, utilization review, or case management experience.

• Preferred certifications include CCMC, CLNC, CMAC, CRRN, CDMS, or COHN.

• Experience with auto liability, general liability, and/or Workers' Compensation.

• Ability to prioritize tasks and work independently as well as within a team.

• Strong time-management, organization, and prioritization skills.

• Excellent analytical abilities.

• Outstanding oral and written communication skills.

• Capability to gather data, compile information, and prepare summary reports.

• Strong interpersonal and conflict resolution skills.

• Experience in a dynamic, fast-paced environment.

• Proven persistence and attention to detail.

• General knowledge of CPT and ICD-9/ICD-10 codes and Medicare guidelines.

• Proficient in Microsoft Word, Excel, and Outlook.

• Ability to maintain composure during stressful situations.

• A customer-service-oriented mindset.

🏝️ Benefits

• Competitive base salary, profit sharing, 401k matching, generous time off, and opportunities for career advancement.

• A relaxed yet vibrant work environment.

• Rising was recognized as a Top Workplace in the healthcare sector for 2023! Discover more about us here: Rising Medical Solutions, Inc Profile (topworkplaces.com).

• Explore our culture on YouTube at: http://www.youtube.com/user/RisingMedical.

• Interested in more? Visit our:

• Facebook: https://www.facebook.com/RisingMedicalSolutions.

• LinkedIn: http://www.linkedin.com/company/rising-medical-sol...

• Glassdoor: http://www.glassdoor.com/Overview/Working-at-Rising-Medical-Solutions-EI_IE322608.11,35.htm pages.