TCM/FCM Hybrid Nurse Case Manager

🔥 9 hours ago

🐊 Florida, Pennsylvania, +2 more states – Remote

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

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Rising Medical Solutions

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1999

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

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

• 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

🎯 Requirements

• 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)

🏖️ Benefits

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

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