Lead Legal Nurse

🕒 May 1

🌽 Illinois – Remote

🌽 Illinois – Remote

⏰ Full Time

🟠 Senior

🧑‍💼 Attorney

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Rising Medical Solutions

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1999

⚕️ Healthcare Insurance

☁️ SaaS

📋 Compliance

Healthcare Insurance • SaaS • Compliance

Rising Medical Solutions is a company that provides comprehensive solutions for managing the costs and quality of medical care. Their services include medical bill review, care optimization, provider negotiations, and analytics and technology solutions aimed at reducing medical costs and improving care outcomes. The company also offers Medicare compliance solutions, utilization review, peer review, and a variety of management services tailored to enhance the efficiency and effectiveness of medical claims management. Rising Medical Solutions focuses on delivering optimal care at the right price, using advanced analytics and risk modeling to inform decisions and improve service delivery for clients.

📋 Description

• 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

🎯 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 • Want to see more? Check out our: • 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 pages