[Hiring] Telephonic Nurse Case Manager @Rising Medical Solutions

Role 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.

• 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.

Qualifications

• An RN License preferably in a compact state AND with an IL license.
• California RN license a plus.
• At least 3 years of TCM experience preferred.
• Experience with Workers’ Compensation or Disability Management.
• Having your BSN, CCM, and/or any other insurance/workers’ compensation certifications is a huge plus!
• Associate degree.

Requirements

• Strong computer skills required – Microsoft Suite (Outlook, Excel, Word, etc.).
• 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.

Benefits

• Competitive base salary, profit sharing, 401k matching, generous time off, and career growth opportunities.
• A relaxed, yet upbeat, work environment.