TCM/FCM Hybrid Nurse Case Manager
R
Rising Medical Solutions, Inc.Workers’ compensation case management
Indiana, United States. Pennsylvania, United States. Tennessee, United States. Florida, United States. Texas, United States, 9:00am CST to 5:30pm CST, with the ability to flex time based on the jurisdictionFull-TimeManager
SalaryCompetitive base salary; profit sharing
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Job Details
- Experience
- 3-5 years of case management experience with 1-2 years of specific worker’s compensation NCM experience
- Required Skills
- Microsoft Excel
Requirements
- Hold a Professional Nursing degree (ASN or BSN).
- Maintain a current, active, unrestricted RN license in the primary residence state; a compact-state license is preferred.
- Have 3–5 years of case management experience, including 1–2 years of workers’ compensation NCM experience.
- Have experience with workers’ compensation, liability, or disability claims.
- Have strong computer skills, including Microsoft Outlook, Excel, and Word.
- Have knowledge of utilization management, case management, and health care across the health continuum.
- Be able to work full time from 9:00am CST to 5:30pm CST, with flexibility based on jurisdiction.
- Demonstrate time management, organization, prioritization, attention to detail, and the ability to work autonomously and as part of a team.
- Demonstrate strong interpersonal and conflict-resolution skills, customer-service-focused oral and written communication, and sensitivity to culturally diverse people and situations.
- Be able to gather data, compile information, and prepare summary reports while maintaining confidentiality.
- Medical bill review experience with workers’ compensation, auto, or health insurance carriers is preferred.
- A California RN license is a plus; CCM and/or other insurance or workers’ compensation certifications are a plus.
Responsibilities
- Maintain a mixed caseload of field and/or telephonic case management files, typically 30–40 cases.
- Establish collaborative relationships and serve as an intermediary among clients, injured or disabled individuals, employers, providers, attorneys, and other involved parties.
- Assess clinical, functional, psychosocial, and vocational needs in high-risk, high-cost, and complex cases.
- Assess, coordinate, implement, monitor, and evaluate individualized care plans using medical necessity, appropriateness-of-care, case management, and managed-care principles.
- Promote quality, cost-effective care across the health care continuum to support optimal function and safe, timely return to work when appropriate.
- Assess injury severity, extent of disability, treatment plans, functional abilities, and physical job requirements to develop return-to-work strategies and help manage future medical exposure.
- Track and report case management activity and maintain organized, timely, accurate clinical documentation.
- Respond to written and telephonic case-status inquiries and document relevant information in Rising systems and client claims systems when applicable.
- Follow applicable quality standards, guidelines, policies, procedures, and reporting requirements; escalate clinical, operational, service, or compliance concerns.
- Assist with URAC accreditation activities and related policies and procedures, and provide nursing insight to Rising Medical Bill Analysis and other internal teams.
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