Legal Nurse Consultant & Healthcare Systems and Facilities
Health maintenance organizations (HMOs) are self-insured organizations that process their own claims and handle their own litigation. Legal nurse consultants that are employed by healthcare systems generally work in the same roles as those that work for insurance companies. They ensure claims are being paid, prevent waste and fraud, and reduce costs.
Legal nurse consultants that are employed by healthcare facilities generally work in risk management positions where their primary duty is to investigate claims involving injury sustained during medical treatment. Usually they work full time and are paid a salary commiserate with similar administrative positions. The job duties typically include interviewing patients and witnesses, reviewing medical records, meeting with management to discuss claims and liability issues, and educating staff.
Some LNCs work in the facility’s litigation department and have duties that include finding and interviewing experts, preparing witnesses for trial, working with external counsel, and obtaining evidence. They may also file reports with the state health department.
Another role a legal nurse consultant may enter at a healthcare facility is in the area of corporate compliance. They would be responsible for helping the facility comply with state and federal laws regarding health care privacy, information management, and crime prevention.