Lead Legal Nurse

The Lead Legal Nurse plays a critical role in evaluating 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.

Requirements

• Leadership experience
• Experience reviewing plaintiff demand packages
• Experience assessing medical records for causation, necessity, and reasonableness, cost
• Experience supporting defensible positions in negotiation, litigation, or audit environments
• Utilization of evidence-based guidelines (ODG, MCG, InterQual, etc.)
• Review and analysis of past and projected cost of medical treatment
• Documentation in Rising’s systems (and client systems as needed)
• Establishing and maintaining collaborative relationships with clients, attorneys, and internal stakeholders

Benefits

• Competitive base salary
• Profit sharing
• 401k matching
• Generous time off