Telephonic Nurse Case Manager

Rising Medical Solutions; California; A distancia; USD 85.000 - 105.000; Jornada completa

Descripción de la vacante

Rising Medical Solutions, LLC is seeking a Telephonic Nurse Care Manager to coordinate care for high-risk individuals. You will evaluate patients, direct treatment plans, discuss claims and eligibility, and manage resources in collaboration with families and healthcare professionals.

Requirements include an RN license (compact state preferred; California license a plus), strong Microsoft Office skills, and at least 3 years of TCM experience.

Formación

• RN license preferred in a compact state.
• California RN license a plus.
• 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.
• Ability to maintain confidentiality of information, policies, and procedures.
• Ability to set priorities and work autonomously and as part of a team.
• Demonstrated sensitivity to culturally diverse people and situations.

Responsabilidades

• Coordinate all aspects of patient care for high-risk individuals.
• Evaluate patients and direct treatment plans; discuss claims, benefits, and eligibility.
• Manage resources and collaborate with patients, families, and other medical professionals.
• Document ongoing progress of all case management activity and maintain files.
• Assess injury severity and return-to-work plans to manage future medical exposure.

Conocimientos

Microsoft Suite

Time management

Communication skills

Customer-service orientation

Autonomy

Conflict resolution

Educación

RN license

Compact state RN license

California RN license (a plus)

Nursing license (registered nurse)

Herramientas

Microsoft Outlook

Microsoft Excel

Microsoft Word

Descripción del empleo

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

• An RN License preferably in a compact state
• 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 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