Rising Medical Solutions

Telephonic Nurse Case Manager

Rising Medical Solutions  •  United States (Remote)  •  21 days ago
Apply
AI can make mistakes so check important info. Chat history is never stored.

Job Description

As our Telephonic Nurse Care Manager, you will coordinate all aspects of patient care for high-risk individuals. You will evaluate each patient while directing treatment plans, discuss claims, benefits, and eligibility, and manage resources while working alongside patients, their families, and other medical professionals.

In this job, you will:

  • Establish collaborative relationships and act as an intermediary between clients, patients, employers, providers, and attorneys
  • Assess, coordinate, implement, monitor, and evaluate the plan to meet the injured/disabled individual’s needs, utilizing the knowledge of medical necessity, care appropriateness, and managed care principles
  • Promote quality, cost-effective care throughout the health continuum to ensure the injured/disabled individual is able to return to an optimal level of work and functioning and documenting case savings
  • Document ongoing progress of all case management activity, including the organized maintenance of files containing clinical documentation of interactions with all parties of every claim
  • Assess injury severity, extent of disability, treatment plans, functional abilities, and physical job requirements to establish return to work plans and strategies to manage future medical exposure

Requirements

  • An RN License preferably in a compact state AND with an IL license
  • California RN license a plus
  • Full Time – 9:00am CST to 5:30pm CST, with the ability to flex time based on the jurisdiction
  • Strong computer skills required – Microsoft Suite (Outlook, Excel, Word, etc.)
  • At least 3 years of TCM experience preferred
  • Experience with Workers’ Compensation or Disability Management
  • The ability to maintain confidentiality of all information, policies, and procedures
  • The ability to set priorities and work both autonomously and as part of a team
  • Demonstrated sensitivity to culturally diverse people and situations
  • Well-developed time management, organization, and prioritization skills
  • Knowledge of utilization management, case management, and healthcare provided throughout the health continuum
  • Excellent oral and written communication skills with a heavy focus on customer-service
  • The ability to gather data, compile information, and prepare summary reports
  • Strong interpersonal and conflict resolution skills
  • Experience in a fast-paced, multi-faceted environment
  • Demonstrated persistence and attention to detail
  • The ability to stay calm during stressful situations
  • Having your BSN, CCM, and/or any other insurance/workers’ compensation certifications is a huge plus!
  • Associate degree

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

About Rising Medical Solutions

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.

Industry
Finance & Insurance
Company Size
51-200 employees
Headquarters
Chicago, IL
Year Founded
1999
Social Media