Bring your expertise to the Rising team to assist with the expansion of our new demand package product!
The Lead Legal Nurse plays a critical role in evaluating the medical necessity, appropriateness, and cost of medical services within auto, general liability, and workers’ compensation claims while leading the direction and the program. This role combines clinical expertise with analytical review to support claim adjudication, demand package evaluation, and dispute resolution.
The ideal candidate has some leadership experience or is looking to step up, along with experience reviewing plaintiff demand packages, assessing medical records for causation, necessity, and reasonableness, cost, and supporting defensible positions in negotiation, litigation, or audit environments. and is successfully able to:
- Evaluate liability demand packages, including medical records, billing, and treatment timelines to identify gaps, inconsistencies, and cost drivers
- Utilize evidence-based guidelines (ODG, MCG, InterQual, etc.) to determine authorization versus escalation to Peer or Physician Review
- Review and analyze past and projected cost of medical treatment.
- Document appropriately in Rising’s systems (and client systems as needed), and issue demand package review report
- Write clear, concise, and defensible nurse summaries on all UR and demand review files.
- Establish and maintain collaborative relationships with clients, attorneys, and internal stakeholders