Legal Nurse: Medical Claims & Utilization Review Expert
Rising Medical Solutions, Inc
Rising Medical Solutions, LLC is seeking a Legal Nurse to evaluate medical necessity within various claims such as auto, general liability, and workers’ compensation. An ideal candidate will possess an Associate or Bachelor’s Degree in nursing and an active RN license, with a minimum of 5 years experience in clinical or legal settings. Responsibilities include analyzing demand packages, utilizing evidence-based guidelines, and maintaining collaborative relationships. The company offers competitive salary and benefits, including 401k matching and generous time off. #J-18808-Ljbffr
- Rising-Medical-Solutions is looking for a Legal Nurse in Chicago, IL to evaluate medical necessity for auto, general... ..., and workers' compensation claims. The ideal candidate will possess... ...experience. Responsibilities include reviewing demand packages and medical records...MedicalLegalClaims
- ...Rising team where our new Legal Nurse plays a critical role in evaluating the medical necessity,... ...workers' compensation claims. This role combines clinical... ...expertise with analytical review to support claim adjudication... ..., and cost drivers Utilize evidence-based guidelines...MedicalLegalClaims
- hireops is seeking a Registered Nurse (RN) for a contract position lasting approximately 9 months. Remote work is available... ...reside in Texas or Illinois. The job involves validating medical necessity, reviewing claims, and communicating with providers and members. The ideal...MedicalClaimsRemote jobContract work
$299 - $653 per month
Overview The Nurse Analyst is responsible for collecting... ...the grand jury. They review, analyze, interpret,... ...detailed summaries of medical records, charts,... ...coding, and Medicaid claims/utilization data. Qualifications... ...office‑provided continuing legal education Semi‑monthly...MedicalLegalClaimsFull timePart timeWork at officeFlexible hours- Rising Medical Solutions in Chicago seeks a Legal Nurse to evaluate medical necessity and appropriateness in various claims. Candidates should have an Associate or Bachelor's Degree in nursing and an active RN license. Responsibilities include assessing demand packages...MedicalLegalClaims
- ...Innovative Systems Group is seeking a Registered Nurse for remote positions in IL, TX, NM, MT, or OK. The role involves collaborating... ...with healthcare providers to optimize member benefits and evaluate medical necessity, ensuring compliance with established guidelines....MedicalRemote work
- ...Description: Job Title: Utilization Review Manager Location: Chicago... ...authorizations to ensure medical necessity, regulatory compliance... ..., reauthorizations, and claims-related issues. Partner with... ...: Masters degree in Nursing, Psychology, Social Work, Health...MedicalClaimsFull timeWork at office
$61.5k - $136.1k
...performing accurate and timely medical review of regular business, state of Texas and national accounts claims suspended for medical... ...Qualifications: ~ Registered Nurse with current, active, unrestricted... ...veteran status, or any other legally protected characteristics....MedicalLegalClaimsPermanent employmentContract work- ...Full-Time Utilization Management Physician Reviewer This full-time role is responsible for provisioning accurate... ...is responsible for ensuring medically appropriate care is recommended to... ...decisions Maintain compliance with legal, regulatory and accreditation requirements...MedicalLegalFull time
$105k - $160k
...Team We are hiring a Senior Claims Specialist – Primary... ...professional development. Utilize knowledge of the legal frameworks and claims handling... ..., and other claim details. Review contracts for risk transfer... ...benefits package that includes medical plans for you and your family...MedicalLegalClaimsWork at office3 days per week$73k - $96k
...Workers Compensation Claims Examiner At AIG, we... ...create an impact Utilize investigation, claim handling... ...identify and review suspect/fraudulent claims... ...and brokers, (medical) experts, clients' lawyers, injured workers or their legal representatives. We want...MedicalLegalClaims- ...Nurse Reviewer (LPN/RN) Pay rate: $27.50/hr W2 Location: Fully Remote... ...key role in supporting disability claims by evaluating medical information and helping facilitate... ...Rehabilitation Medicine Home Health Utilization Review or Medical Review Must-...MedicalClaimsRemote work
$80k - $110k
...Senior Claims Examiner (Permanent) Job Type: Permanent... ...with minimal supervision. Reviews and analyzes claim documentation and legal filings to set timely... ...to manage deployment and utilization of defense counsel. Identifies... ..., dental and FSA plans (medical, limited purpose, and...MedicalLegalClaimsPermanent employmentTemporary workWork at office2 days per week$60k - $70k
...Overview Position Title: Multi Line Claim Representative I Location: Hybrid – Reporting... ...guidelines and direct supervision. Review medical, legal and miscellaneous invoices to... ...payment of multi-line liability claims utilizing a claim payment program in accordance...MedicalLegalClaimsLocal areaRemote workMonday to Friday- ...Medicine physicians to conduct Independent Medical Exams (IME) and Peer Reviews. This opportunity allows you to customize your... .../South Chicago Area JOB SUMMARY: Utilizes clinical expertise, and reviews disability claims by providing an interpretation of the medical...MedicalClaimsFor contractorsMonday to Friday
- ...defense, sustainability, legal requirements and... ...monitoring, track and trace, claims management, invoice... ...contribute You will: Review and analyze stock... ...Analyze and verify capacity utilization, performance and KPI monitoring... ...8-813-9665 Rewards: Medical, dental, vision 401k...MedicalLegalClaimsVisa sponsorshipWork visaShift work
- ...audits of delegated vendors, medical groups, IPAs, and subcontractors... ...delegate performance, review compliance reports, and ensure... ...documentation. Serve as a subject matter expert on state and federal... ...clinical, behavioral health, utilization management, quality improvement...MedicalContract workFor subcontractorWork at officeRemote workMonday to FridayNight shift
- ...opportunities for employers to utilize the pharmacy as a... ...with internal teams (legal, finance, operations, pharmacy... ...comparisons, contract reviews, and partner summaries.... ...Working knowledge of claim adjudication,... .... #J-18808-Ljbffr Insight Hospital and Medical CenterMedicalLegalClaimsContract workFor contractors
$54.75k - $97.5k
...Auto Casualty Claims Specialist Are you an experienced Auto Bodily... ...& Responsibilities: Review & determine course of action on each file assigned, utilizing technical knowledge & experience... .../remote ~ Knowledge of legal and medical terminology ~ Excellent negotiation...MedicalLegalClaimsFull timeTemporary workWork at officeRemote workFlexible hours$70k - $80k
Multi-Line Claim Consultant Position Title: Multi-Line Claim Consultant... ...established reserve authority levels. Review, approve or provide oversight of medical, legal, damage estimates and... ...accordance with CCMSI claim procedures utilizing a claim payment program in accordance...MedicalLegalClaimsRemote work- ...financial records, healthcare claims, tax records,... ...financial activities. Utilize electronic databases to identify... ...qualifications: Experience reviewing and understanding medical records and knowledge of... ...working with a federal or state legal or law enforcement entity....MedicalLegalClaimsFull timeWork experience placementInterim roleWork at officeLocal areaRemote workFlexible hours
$45 per hour
...seeking a local contract nurse RN School RN for a... ...clinic Administer medications and monitor student health... ...FERPA compliance) Utilize clinical judgment to... ...Comply with applicable legal obligations We... ...and your rights, please review our full Privacy Notices...MedicalLegalHourly payWeekly payFull timeContract workPart timeLocal areaMonday to Friday- ...financial records, healthcare claims, tax records,... ...to financial activities. Utilize electronic databases to identify... ...Qualifications Experience reviewing and understanding medical records and knowledge of medical... ...with a federal or state legal or law enforcement entity....MedicalLegalClaimsFull timeWork experience placementInterim roleWork at officeLocal areaFlexible hours
- ...including ongoing claim reporting, rate setting... ...service teams to review findings and trends... ..., and project medical/Rx loss trends and... ...insights to clients. Utilize actuarial and financial... ...Subject Matter Expert on financial and actuarial... ...to detail. Legal right to work in the...MedicalLegalClaimsInternshipLocal area
- ...Illinois bar. Responsibilities Gather and review medical evidence and records. Take depositions... ...parties. Conduct discovery and perform legal research. Draft pleadings, motions, and... ...at various proceedings. Communicate with claims representatives and monitor reports. Assist...MedicalLegalClaimsWork at officeLocal area
$75k - $100k
Workers’ Compensation Claim Supervisor - Midwest National Accounts... .... Responsibilities Review, assign and provide supervision... ...levels. Provide oversight of medical, legal, damage estimates and miscellaneous... ...with claim procedures utilizing a claim payment program in accordance...MedicalLegalClaimsRemote workMonday to Friday$125k - $155k
...and forward-thinking Claims team! Here, you’ll be... ...partners (e.g., outside experts and/or legal counsel; underwriting... ...and denial letters Reviews and provides analysis... ..., negotiation and utilization of alternative dispute... ...dental and FSA plans (medical, limited purpose, and...MedicalLegalClaimsPermanent employmentTemporary workWork at officeLocal areaFlexible hours- ...Hmong Chinese Language Document Reviewer Employment Type: Full Time, Mid-Level Department: Legal As a CGS Hmong Chinese Document... ...rules to show cause, proofs of claim, motions for summary judgment,... ...written documents and materials utilizing a wide range of office software...LegalClaimsFull timeWork at officeFlexible hours
$75k - $87k
...educational workshops, reviewing professional... ...and apply knowledge of legal requirements and government... ...regarding eligibility, claims, coverage, retirement... ...related to enrollment, utilization, and benefits costs.... ...~12 Paid Holidays ~ Medical ~ Dental ~ Vision...MedicalLegalClaimsFull timeTemporary workPart timeWork at office$104.36k - $162.42k
...currently looking for an Actuarial Expert based in Chicago. This is a... ...booked NLR via annual reserve reviews. Support the reserving team... ...Collabore with underwriting, claims and pricing teams to understand... ...(consolidation processes, legal vs management view) allowing for...LegalClaimsContract workLocal areaFlexible hours
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