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:
Requirements
Benefits
If you are ready to join a team of professionals dedicated to making a difference and making lives better, please apply today!
Rising Medical Solutions is a national managed care firm that provides medical cost containment and medical care management services to the workers' compensation, auto, liability, and group health markets. Our client base includes insurance carriers, TPAs, self-insured employers, and public-sector and government entities of varying sizes from small to large tier.
Since 1999, our managed care services have positively impacted hundreds of thousands of employee lives and saved billions in total claim costs for payers across the country. Our flagship bill review service and technologies consistently deliver over 60% in national bill review savings, which includes application of fee schedule/UCR rates, network discounts, nurse audits, provider negotiations, and embedded fraud detection capabilities.
However, our solutions portfolio goes far beyond the standard repricing of medical bills. Our integrated programs deliver clinical and cost-saving expertise before, during, and after treatment. Our proprietary VISION™ platform is the industry’s only multi-product, multi-line, single-sign-on, medical management enterprise system. VISION™ provides claims professionals with unprecedented ancillary referral and medical management capabilities across the entire medical care continuum, from early intervention to payment processing. Together with our passionate, mission-driven employees, Rising delivers an unparalleled user experience for those providing, receiving, and paying for medical care.
Rising also directs and publishes the annual Workers’ Compensation Benchmarking Study, a national research program examining the complex forces impacting claims management in workers’ compensation today. The study has become one of the most cited research publications in the industry and has been the subject of numerous articles, webinars, and conference presentations since its 2013 inception.
