Lead Legal Nurse

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

📋 Description

• Assess liability demand packages, which include medical records, billing information, and treatment timelines to pinpoint gaps, inconsistencies, and factors influencing costs.

• Apply evidence-based guidelines (such as ODG, MCG, InterQual, etc.) to evaluate whether authorization is needed or if escalation to Peer or Physician Review is necessary.

• Analyze both past and anticipated costs associated with medical treatment.

• Accurately document in Rising’s systems (and client systems as required) and generate demand package review reports.

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

• Foster and sustain collaborative relationships with clients, attorneys, and internal stakeholders.

⛳️ Requirements

• An Associate or Bachelor’s Degree in nursing.

• Possess an active RN license in one or more states.

• Previous experience in drafting and/or reviewing liability demand packages or assisting in claim litigation/negotiation (strongly preferred).

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

• Certifications such as CCMC, CLNC, CMAC, CRRN, CDMS, or COHN (preferred).

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

• Ability to prioritize tasks and work both independently and collaboratively as part of a team.

• Strong time-management, organizational, and prioritization abilities.

• Excellent analytical capabilities.

• Outstanding oral and written communication skills.

• Proficient in gathering data, compiling information, and preparing summary reports.

• Strong interpersonal and conflict resolution skills.

• Experience working in a dynamic, fast-paced environment.

• Proven persistence and meticulous attention to detail.

• Basic understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines.

• Proficient in Microsoft Word, Excel, and Outlook.

• Ability to maintain composure in high-pressure situations.

• A customer-service-oriented mindset.

🏝️ Benefits

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

• A relaxed yet vibrant work environment.

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

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

• Interested in more? Visit us on:

• 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.