Job Description
Join the Rising team where our new Legal Nurse plays a critical role in evaluating the medical necessity, appropriateness, and cost of medical services within auto, general liability, and workers’ compensation claims. This role combines clinical expertise with analytical review to support claim adjudication, demand package evaluation, and dispute resolution.
The ideal candidate has experience reviewing plaintiff demand packages, assessing medical records for causation, necessity, and reasonableness, cost, and supporting defensible positions in negotiation, litigation, or audit environments. and is successfully able to:
+ 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 m...
The ideal candidate has experience reviewing plaintiff demand packages, assessing medical records for causation, necessity, and reasonableness, cost, and supporting defensible positions in negotiation, litigation, or audit environments. and is successfully able to:
+ 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 m...