About Us:

Headquartered in Chicago, RISING Medical Solutions is a privately held, financial solutions organization offering medical cost containment and care management services. With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, Fortune 1000 employers, third party administrators, and government organizations. At RISING, we’re committed to:

• Continuous technological improvement
• Entrepreneurial attitude
• Seven core values that emphasize teamwork, ethical behavior, customer service, continual improvement, positive attitude, focusing on what's important, and keeping a sense of humor
• Responding quickly to client needs
• Being the best, not the biggest

The Role:

The Injury Coordinator is responsible for coordinating and managing a range of health care related services such as, communicating with patients, providers, adjusters, etc. to determine appropriate treatment, and to secure a timely return to work status for the injured workers.

Core Responsibilities include:

• Facilitate and schedule appointments as needed and keep the Telephonic Nurse Case Manager (TCM), clients, claimants, providers, and employers informed verbally and/or in writing of any changes, delays, updates, or problems.
• Manage and/or assign files to appropriate staff member and initiate appropriate verbal and/or written contacts with employers, clients, claimants, and medical providers.
• Set up files in all appropriate systems; assign files, when applicable, to the nurse.
• Maintain responsibility of an individual caseload
• Maintain appropriate electronic and paper files.
• Obtain authorization for medical release of information from the adjuster, as necessary, for records acquisition.
• Provide care direction as necessary.
• Interface with a variety of inter-disciplinary providers (e.g., PT, diagnostic, psychology, etc.).
• Identify, maintain, and update participating providers.
• Utilize Triage scoring tool for evaluating case risk and input all activities (including verbal and written discussions) into the Ultimate database and customer/client system.
• Answer incoming calls and direct the call appropriately.
• Process all documents using computer, copier, and scanner.
• Search and copy the appropriate internal criteria guidelines, when appropriate.
• Screen all re-open files (subsequent URs) to determine duplicate requests, vs. an appeal request that is beyond the allotted timeframe vs. a reconsideration vs. a new UR.
• Work as part of a team to meet turn-around time for the set activity.
• Keep supervisor advised of any problems or delays.
• Continually improve job skills and knowledge of all company products and services as well as customer issues and needs, through ongoing training and self-directed research.
• Adhere to company policies, procedures, and reporting requirements.

Reports to:

Injury Coordinator Team Lead and Technical Manager

Requirements

• Bilingual in Spanish is a plus
• Experience in any of the following disciplines a plus – CNA, Medical Office Manager, Medical Assistant, Physical Therapy Aide, Workers’ Compensation/Medical Unit Claims Administrator, IME Coordinator
• Experience with workers’ compensation or disability (a plus!)
• Intermediate computer and internet skills (will work with programs including MS Word, Outlook, and Excel)
• Basic knowledge of/ability to read medical reports
• The ability to research evidence-based guidelines
• An understanding of workflow guidelines and follow as necessary
• Proficient verbal/telephone and written communication skills
• A high level of efficiency, ability to maintain rapid workflow
• An aptitude for learning, organization skills and the ability to follow systems and procedures
• A time-management mindset, along with planning, and prioritization skills
• The ability to multi-task in a fast-paced environment
• The ability to work independently as well as part of a team
• The ability to express empathy with injured and/or disabled people
• A customer service mindset

Physical/Mental Demands:

• Visual Acuity
• Talking
• Hearing
• Working remotely some or all the time
• Remaining in a seated position for 8 hours a day
• Ability to view a computer for a long period of time

Benefits

• Health insurance (4 different plans to choose from)
• Dental
• Vision
• Paid time off (PTO) or Flexible Time Off (FTO)
• 401(k)
• Basic Life Insurance and Long-Term Disability Insurance (paid by the company)
• Voluntary Life Insurance and Short-Term Disability Insurance
• Flexible Spending Accounts (FSA)
• Employee Assistance Program (EAP)
• Rise Well Wellness Program
• Professional Development Reimbursement Program (PDRP)
• You will be part of our new Elevate program designed to recognize and reward employees for their hard work