[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.

In this job, you will:

• 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.
• 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.