Lead Legal Nurse - Remote

Overview

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.

In Short

• 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

• Leadership experience or willingness to step up.
• Experience reviewing plaintiff demand packages.
• Expertise in assessing medical records for causation, necessity, and reasonableness.
• Ability to support defensible positions in negotiation, litigation, or audit environments.

Benefits

• Opportunity to work with a dynamic team.
• Engagement in meaningful work that impacts lives.
• Professional growth opportunities.