Legal Nurse

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

📋 Description

• Assessing liability demand packages, which includes reviewing medical records, billing information, and treatment timelines to pinpoint gaps, discrepancies, and cost drivers.

• Applying evidence-based guidelines (such as ODG, MCG, and InterQual) to make decisions on authorization or escalation to Peer or Physician Review.

• Analyzing both historical and anticipated costs related to medical treatment.

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

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

• Building and nurturing 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, reviewing liability demand packages, or supporting claim litigation/negotiation (strongly preferred).

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

• 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 independently as well as part of a team.

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

• Excellent analytical abilities.

• Outstanding oral and written communication skills.

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

• Strong interpersonal and conflict resolution capabilities.

• 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 in stressful 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 energetic work environment.

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

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

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