Legal Nurse

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

📋 Description

• Assessing liability demand packages, which include medical records, billing statements, and treatment timelines, to uncover gaps, discrepancies, and cost drivers.

• Applying evidence-based guidelines (e.g., ODG, MCG, InterQual) to decide between authorization or escalation for Peer or Physician Review.

• Analyzing historical and anticipated costs associated with medical treatment.

• Accurately documenting information in Rising’s systems (and client systems when necessary) and generating demand package review reports.

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

• Building and sustaining collaborative relationships with clients, attorneys, and internal stakeholders.

⛳️ Requirements

• An Associate or Bachelor’s Degree in nursing is required.

• Must possess an active RN license in one or more states.

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

• A minimum of 5 years' experience in clinical settings, legal matters, utilization review, or case management is required.

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

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

• 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 abilities.

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

• Proven persistence and attention to detail.

• General knowledge of CPT and ICD-9/ICD-10 coding as well as Medicare guidelines.

• Proficient in Microsoft Word, Excel, and Outlook.

• Ability to maintain composure in 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 industry for 2023! View our profile here: Rising Medical Solutions, Inc Profile (topworkplaces.com).

• We're featured on YouTube! Explore our culture at: http://www.youtube.com/user/RisingMedical.

• Interested in more? Connect with 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.