Lead Legal Nurse

Rising Medical Solutions

Lead Legal Nurse evaluating medical necessity and cost in claims for auto, general liability, and workers’ compensation. Collaborate with clients and internal stakeholders in Rising's healthcare team.

Posted 5/2/2026full-timeRemote • Illinois • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

nursingutilization reviewliability demand packagesCPT codesICD-9 codesICD-10 codesMedicare guidelinesdata analysissummary report preparationcost analysis

Soft Skills

analytical skillsoral communicationwritten communicationinterpersonal skillsconflict resolutiontime managementorganizationprioritizationautonomyteam collaboration

Certifications

RN licenseCCMCCLNCCMACCRRNCDMSCOHN