Legal Nurse

Role Overview

• Evaluating liability demand packages, including medical records, billing, and treatment timelines to identify gaps, inconsistencies, and cost drivers
• Utilizing evidence-based guidelines (ODG, MCG, InterQual, etc.) to determine authorization versus escalation to Peer or Physician Review
• Reviewing and analyzing past and projected cost of medical treatment.
• Documenting appropriately in Rising’s systems (and client systems as needed), and issuing demand package review report
• Writing clear, concise, and defensible nurse summaries on all UR and demand review files.
• Establishing and maintaining collaborative relationships with clients, attorneys, and internal stakeholders

Requirements

• An Associate or Bachelor’s Degree in nursing
• Hold an active RN license in one or more states
• Experience reviewing drafting and/or reviewing liability demand packages or supporting claim litigation/negotiation (strongly preferred)
• Minimum 5 years of clinical, legal, utilization review, or case management experience
• Certifications such as CCMC, CLNC, CMAC, CRRN, CDMS, or COHN (preferred)
• Experience with auto liability, general liability, and/or Workers' Compensation
• The ability to set priorities and work both autonomously and as a team member
• Well-developed time-management, organization, and prioritization skills
• Excellent analytical skills
• Superb oral and written communication
• The ability to gather data, compile information, and prepare summary reports
• Strong interpersonal and conflict resolution skills
• Experience in a fast-paced, multi-faceted environment
• Demonstrated persistence and attention to detail
• General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines
• Working knowledge of: Microsoft Word, Excel, and Outlook
• Ability to remain calm during stressful situations
• A customer-service mindset

Benefits

• Competitive base salary, profit sharing, 401k matching, generous time off, and career growth opportunities
• A relaxed, yet upbeat, work environment
• Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Rising Medical Solutions, Inc Profile (topworkplaces.com)
• We're on YouTube! Check out our culture at: http://www.youtube.com/user/RisingMedical
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• EI_IE322608.11,35.htm pages