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Rising Medical Solutions

Medical cost containment and care management

Telephonic Nurse Case Manager

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeRemote in USARemote

About the Job

Requirements

  • An RN license is required; a license in a compact state is preferred.
  • A California RN license is a plus.
  • Strong computer skills, including Microsoft Suite applications such as Outlook, Excel, and Word, are required.
  • Experience with workers’ compensation or disability management is required.
  • The role requires maintaining confidentiality of information, policies, and procedures.
  • The ability to set priorities and work autonomously as well as collaboratively is required.
  • Sensitivity to culturally diverse people and situations is required.
  • Well-developed time management, organization, and prioritization skills are required.
  • Knowledge of utilization management, case management, and healthcare provided throughout the health continuum is required.
  • Oral and written communication skills, with a strong customer-service focus, are required.
  • The ability to gather data, compile information, and prepare summary reports is required.
  • Interpersonal and conflict-resolution skills are required.
  • Experience in a fast-paced, multifaceted environment is required.
  • Persistence and attention to detail are required.
  • The ability to remain calm during stressful situations is required.
  • An associate degree is required.

Responsibilities

  • Establish collaborative relationships and act as an intermediary between clients, patients, employers, providers, and attorneys.
  • Assess, coordinate, implement, monitor, and evaluate care plans to meet the needs of injured or disabled individuals, applying knowledge of medical necessity, care appropriateness, and managed care principles.
  • Promote quality, cost-effective care throughout the health continuum to help injured or disabled individuals return to an optimal level of work and functioning, and document case savings.
  • Document ongoing case-management activity and maintain organized files containing clinical documentation of interactions with all parties involved in each claim.
  • Assess injury severity, extent of disability, treatment plans, functional abilities, and physical job requirements to establish return-to-work plans and strategies for managing future medical exposure.

Desired Qualifications

  • At least 3 years of TCM experience is preferred.
  • A BSN, CCM, or other insurance or workers’ compensation certifications are a plus.

About the Company

Rising Medical Solutions

Medical cost containment and care management

Rising Medical Solutions is a national managed care firm offering medical cost containment and care management for workers’ compensation, auto, liability, and group health markets. Its flagship bill review saves over 60% by applying fee schedules, network discounts, nurse audits, provider negotiations, and fraud detection, while its broader programs cover the full medical care continuum. The proprietary VISION platform is a single-sign-on medical management system that provides claims professionals with referrals and management tools across the entire care process. The company also publishes the annual Workers’ Compensation Benchmarking Study to inform the industry and drive improvements in claims management. Its goal is to lower claim costs, improve care outcomes, and deliver a smooth experience for everyone involved in the medical care and claims process.

Company size
51-200
Company stage
Not listed
Total funding
Not listed
Headquarters
Chicago, IL
Founded
1999

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