TCM/FCM Hybrid Nurse Case Manager

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Oversee care for individuals who are injured or disabled, focusing on high-risk, high-cost, and complex cases.

• Manage a diverse caseload of field and/or telephonic case management files, typically consisting of 30–40 cases.

• Build collaborative relationships and act as a liaison among clients, injured or disabled individuals, employers, providers, attorneys, and other relevant parties.

• Evaluate clinical, functional, psychosocial, and vocational needs.

• Plan, coordinate, implement, monitor, and assess personalized care plans.

• Advocate for quality, cost-effective care throughout the healthcare continuum.

• Facilitate optimal function and ensure safe, timely return to work when feasible.

• Assess the severity of injuries, disabilities, treatment plans, functional abilities, and physical job requirements.

• Formulate return-to-work strategies and assist in managing future medical risks.

• Monitor and report on case management activities.

• Maintain well-organized, timely, and accurate clinical documentation.

• Address written and telephonic inquiries regarding case status.

• Record pertinent case information in Rising systems and client claims systems when applicable.

• Adhere to relevant state, national, accreditation, departmental, and client-specific standards, policies, procedures, and reporting requirements.

• Elevate clinical, operational, service, or compliance issues to the appropriate supervisor.

• Aid in URAC accreditation efforts and related policies and procedures.

• Offer professional nursing expertise to Rising Medical Bill Analysis and other internal teams.

⛳️ Requirements

• Must possess a current, active, unrestricted RN license in the state of primary residence, with preference for a compact state license.

• California RN license is an advantage.

• Full-time position – 9:00 AM CST to 5:30 PM CST, with flexibility based on jurisdiction.

• Proficient computer skills are required, including Microsoft Suite (Outlook, Excel, Word, etc.).

• 3-5 years of case management experience, including 1-2 years specifically in worker’s compensation NCM.

• Familiarity with Workers’ Compensation, liability, or disability claims.

• Preferred experience in medical bill review with Workers’ Compensation, Auto, or Health Insurance carriers.

• Ability to maintain confidentiality regarding all information, policies, and procedures.

• Capability to prioritize tasks and work both independently and collaboratively within a team.

• Demonstrated awareness of culturally diverse individuals and situations.

• Strong skills in time management, organization, and prioritization.

• Knowledge of utilization management, case management, and healthcare delivery throughout the health continuum.

• Excellent verbal and written communication skills with a strong emphasis on customer service.

• Ability to collect data, compile information, and create summary reports.

• Strong interpersonal and conflict resolution abilities.

• Experience in a fast-paced, multifaceted environment.

• Proven persistence and attention to detail.

• Ability to remain calm in stressful situations.

• Holding a CCM and/or other insurance/workers’ compensation certifications is a significant advantage!

• Professional Nursing degree (ASN, BSN) is required.

🏝️ Benefits

• Competitive base salary.

• Profit sharing.

• 401k matching.

• Generous time off.

• Opportunities for career advancement.

• A relaxed yet dynamic work environment.