Description
Position Summary
The Legal Nurse Consultant is responsible for conducting detailed clinical reviews of senior living medical records and related documentation to evaluate quality of care, clinical appropriateness, regulatory standards, and internal guidelines. This position requires an experienced nursing professional with long-term care and legal nurse consultant expertise.
Key Responsibilities
Review and interpret medical records, incident reports, and claim-related documentation involving nursing home residents.
Assess clinical documentation for accuracy, completeness, and consistency with standards of care.
Evaluate cases for quality-of-care concerns, potential liability issues, and regulatory compliance considerations.
Collaborate with claims professionals, risk management staff, and other internal stakeholders to support timely and well-informed claim evaluations.
Prepare clear, concise, and well-supported written summaries of clinical findings and recommendations.
Maintain strict confidentiality and compliance with HIPAA and all applicable legal and regulatory requirements.
Requirements
Qualifications
Active and unrestricted Registered Nurse (RN) license required.
Bachelor of Science in Nursing (BSN) preferred.
Minimum of 3 to 5 years of clinical nursing experience in long-term care, skilled nursing, geriatric care, or a related setting.
Prior experience in insurance review, utilization review, legal nurse consulting, or risk management strongly preferred.
Legal Nurse Consultant Certified (LNCC) credential preferred.
Strong analytical, critical thinking, organizational, and written communication skills.
Demonstrated ability to work independently in a fully virtual environment.
Proficiency with electronic medical records systems and standard Microsoft Office applications.
