Legal Nurse - Remote

Overview

Join the Rising team where our new 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. 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

• Experience reviewing plaintiff demand packages
• Ability to assess medical records for causation, necessity, and reasonableness
• Strong analytical skills
• Experience in negotiation, litigation, or audit environments
• Excellent documentation skills

Benefits

• Collaborative work environment
• Opportunity to work with a diverse team
• Professional development opportunities
• Competitive salary and benefits package