Nurse Case Manager

🕒 May 6

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Rising Medical Solutions

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1999

⚕️ Healthcare Insurance

☁️ SaaS

📋 Compliance

Healthcare Insurance • SaaS • Compliance

Rising Medical Solutions is a company that provides comprehensive solutions for managing the costs and quality of medical care. Their services include medical bill review, care optimization, provider negotiations, and analytics and technology solutions aimed at reducing medical costs and improving care outcomes. The company also offers Medicare compliance solutions, utilization review, peer review, and a variety of management services tailored to enhance the efficiency and effectiveness of medical claims management. Rising Medical Solutions focuses on delivering optimal care at the right price, using advanced analytics and risk modeling to inform decisions and improve service delivery for clients.

📋 Description

• 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

• Competitive base salary, profit sharing, 401k matching, generous time off, and career growth opportunities • A relaxed, yet upbeat, work environment • Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Rising Medical Solutions, Inc Profile (topworkplaces.com) • We're on YouTube! Check out our culture at: http://www.youtube.com/user/RisingMedical • Want to see more? Check out our: • Facebook: https://www.facebook.com/RisingMedicalSolutions • LinkedIn: http://www.linkedin.com/company/rising-medical-sol... • Glassdoor: http://www.glassdoor.com/Overview/Working-at-Rising-Medical-Solutions- EI_IE322608.11,35.htm pages