Nurse Case Manager

🔥 16 hours ago

🇺🇸 United States – 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

• Establish collaborative relationships and act as an intermediary between clients, patients, employers, providers, and attorneys • Assess, coordinate, implement, monitor, and evaluate care plans for injured or disabled individuals • Apply knowledge of medical necessity, care appropriateness, and managed care principles • Promote quality, cost-effective care throughout the health continuum • Help injured or disabled individuals return to an optimal level of work and functioning • Document case savings • Document ongoing progress of case management activities • Maintain organized files containing clinical documentation of interactions with all parties for every claim • Assess injury severity, disability extent, treatment plans, functional abilities, and physical job requirements • Establish return-to-work plans and strategies to manage future medical exposure • Coordinate all aspects of patient care for high-risk individuals • Evaluate patients, direct treatment plans, discuss claims, benefits, and eligibility, and manage resources alongside patients, families, and medical professionals

🎯 Requirements

• An RN License 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.) • At least 3 years of TCM experience preferred • Experience with Workers’ Compensation or Disability Management • 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 • BSN, CCM, and/or other insurance/workers’ compensation certifications are a plus • Associate degree

🏖️ Benefits

• Competitive base salary • Profit sharing • 401k matching • Generous time off • Career growth opportunities • A relaxed, yet upbeat, work environment • Named a Top Workplace in the healthcare industry for 2023

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