Lead Legal Nurse RN

Job Summary

To support the expansion of a new demand package product, the full-time remote Lead Legal Nurse RN will evaluate medical necessity and appropriateness of services in auto, general liability, and workers' compensation claims while leading program direction and ensuring defensible positions in negotiations and litigation.

Key responsibilities

• Evaluate liability demand packages, including medical records and treatment timelines, to identify inconsistencies and cost drivers
• Utilize evidence-based guidelines to determine authorization needs and escalate cases as necessary
• Document findings in systems and prepare clear, concise nurse summaries for demand review files

Required qualifications

• Associate or Bachelor's Degree in nursing
• Active RN license in one or more states
• Minimum 5 years of clinical, legal, utilization review, or case management experience
• Experience with liability demand packages and supporting claim litigation/negotiation (strongly preferred)
• Certifications such as CCMC, CLNC, CMAC, CRRN, CDMS, or COHN (preferred)