Rising Medical Solutions
Insurance
TelephonicNurseCaseManager
Neural analysis suggests this role is
optimal for Mid candidates.
“Telephonic Nurse Case Manager at Rising Medical Solutions. Skills: Telephonic Nurse Care Manager, patient care coordination, treatment planning, claims, benefits, and eligibility discussion, resource management. coordinate all aspects of patient care for high-risk individuals. evaluate each patient while directing treatment plans”
What You'll Achieve.
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; establish return to work plans and strategies to manage future medical exposure
Industry & Context.
interpersonal and conflict resolution skills
Full Time – 9:00am CST to 5:30pm CST, with the ability to flex time based on the jurisdiction
What They're Looking For.
Must Have
RN License preferably in a compact state AND with an IL license, 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, Excellent oral and written communication skills with a heavy focus on customer-service, The ability to gather data, compile information, and prepare summary reports, 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
Nice to Have
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!
What You'll Do.
coordinate all aspects of patient care for high-risk individuals
evaluate each patient while directing treatment plans
manage resources while working alongside patients
and other medical professionals
and evaluate the plan to meet the injured/disabled individual’s needs
utilizing the knowledge of medical necessity
and managed care principles
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
and physical job requirements to establish return to work plans and strategies to manage future medical exposure
How You'll Work.
Team & Collaboration
Establish collaborative relationships and act as an intermediary between clients, patients, employers, providers, and attorneys; working alongside patients, their families, and other medical professionals; work both autonomously and as part of a team
Communication Scope
Excellent oral and written communication skills with a heavy focus on customer-service
Full Job 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 **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 least 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
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