TCM/FCM Hybrid Nurse Case Manager

🕒 Novembro 3

🐊 Florida, Pennsylvania, +2 estados a mais – Remoto

🐊 Florida – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 10%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 8 dias.
• As vagas desta empresa costumam ser preenchidas em 49 dias.
• Sem salário divulgado.

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Rising Medical Solutions

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 1999

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

A Rising Medical Solutions é uma empresa que oferece soluções abrangentes para gerenciar os custos e a qualidade do atendimento médico. Seus serviços incluem revisão de contas médicas, otimização do atendimento, negociações com prestadores e soluções de tecnologia e análise, voltadas para a redução de custos médicos e melhoria dos resultados do atendimento. A empresa também oferece soluções de conformidade com o Medicare, revisão de utilização, revisão por pares e uma variedade de serviços de gestão adaptados para melhorar a eficiência e eficácia da gestão de sinistros médicos. A Rising Medical Solutions foca na entrega de atendimento de qualidade ao preço certo, usando análises avançadas e modelagem de risco para informar decisões e melhorar a prestação de serviços para os clientes.

Descrição

• Coordinate care for injured or disabled individuals, including high-risk, high-cost, and complex cases • Maintain a mixed caseload of field and/or telephonic case management files, typically 30–40 cases • Establish collaborative relationships and serve as an intermediary among clients, injured or disabled individuals, employers, providers, attorneys, and other involved parties • Assess clinical, functional, psychosocial, and vocational needs • Assess, coordinate, implement, monitor, and evaluate individualized care plans • Promote quality, cost-effective care across the healthcare continuum • Support optimal function and safe, timely return to work when appropriate • Assess injury severity, disability, treatment plans, functional abilities, and physical job requirements • Develop return-to-work strategies and help manage future medical exposure • Track and report case management activity • Maintain organized, timely, and accurate clinical documentation • Respond to written and telephonic case-status inquiries • Document relevant case information in Rising systems and client claims systems when applicable • Follow applicable state, national, accreditation, departmental, and client-specific standards, policies, procedures, and reporting requirements • Escalate clinical, operational, service, or compliance concerns to the appropriate supervisor • Assist with URAC accreditation activities and related policies and procedures • Provide professional nursing insight to Rising Medical Bill Analysis and other internal teams

🎯 Requisitos

• Current, active, unrestricted RN license in primary residence state and preferably in a compact state • 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.) • 3-5 years of case management experience with 1-2 years of specific worker’s compensation NCM experience • Experience with Workers’ Compensation, liability, or disability claims • Medical bill review experience with Workers’ Compensation, Auto, or Health Insurance carriers is preferred • Ability to maintain confidentiality of all information, policies, and procedures • 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 • 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 • Ability to stay calm during stressful situations • Having your CCM, and/or any other insurance/workers’ compensation certifications is a huge plus! • Professional Nursing degree (ASN, BSN)

🏖️ Benefícios

• Competitive base salary • Profit sharing • 401k matching • Generous time off • Career growth opportunities • A relaxed, yet upbeat, work environment

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