Perform all aspects of the utilization review process.
Review records and utilization review requests received by mail, email, fax, or phone.
Use evidence-based guidelines to determine whether authorization can be given or a file should be sent for peer or physician review.
Write nurse summaries for utilization review files.
Document activity in Rising's database and client databases when appropriate, and send determination letters for completed reviews.
Build collaborative relationships with clients, patients, employers, providers, and attorneys.
Track ongoing utilization review activity to meet appropriate turnaround times.
Maintain organized files with clinical documentation of interactions with all parties to each claim.
Respond to written and telephone inquiries about case status.
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About Rising Medical Solutions
Rising Medical Solutions transforms complex healthcare processes to make lives better. You will join a company dedicated to medical cost containment and care management. We simplify medical care for workers’ compensation, auto, liability, and group health markets. Our proprietary VISION™ 3.0 platform, launched in 2020, streamlines claims administration. It provides a unified medical management portal for our payer customers. This platform integrates our care management and cost containment services. It offers single sign-on access to ancillary services through partners. We serve a diverse client base including insurance carriers, self-insured employers, and government entities. Our estimated annual revenue is $62.7 million.
How We Work
You will thrive in our fast-paced, driven, and diverse culture. We value an entrepreneurial spirit. We are a strengths-based organization that promotes continuous learning. Collaboration is key to our success. We foster team building with initiatives like "Friday Toasts" and "High Fives" for coworker recognition. Our internal newsletter, "The Rising Stone," keeps everyone informed. We host quarterly "Town Halls" to share company updates. An online learning portal, "Rising University," supports your development. We offer flexible work arrangements, including remote positions. We were named a Top Workplace in the healthcare industry in 2023. Many roles are fully remote within the United States.
Engineering at Rising Medical Solutions
You will work with our proprietary, cloud-based technology stack. Our VISION™ 3.0 platform incorporates artificial intelligence (AI). This AI is used for intervention flagging and evidence-based treatment alerts. You will solve challenges in streamlining claims administration. You will contribute to advanced analytics and risk modeling solutions. Your work will impact Rx intelligence and payer web portals. We seek individuals with experience in implementing client-server and web-based applications. Experience with business process reengineering and requirements analysis is valuable. Working knowledge of database and data modeling tools and concepts is a plus.
Why Join Us
Contribute to a company making lives better through healthcare process simplification.
Work on a proprietary cloud-based platform using AI for real-world impact.
Grow your career in a company committed to staff development and promoting from within.
Collaborate with a supportive team that values continuous learning and recognition.
Benefits & Perks
Health, dental, and vision insurance
401(k) with company match
Paid time off and paid holidays
Professional development reimbursement assistance
Fitness subsidies
Company-paid counseling sessions
Relaxed yet upbeat work environment
Jeans professional dress code when onsite (Chicago office)