Telephonic Nurse Case Manager

Rising Medical Solutions

4h•Remote

About The Position

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

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 lest 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
Associate degree

Nice To Haves

Having your BSN, CCM, and/or any other insurance/workers’ compensation certifications is a huge plus!

Responsibilities

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