TCM/FCM Hybrid Nurse Case Manager

Rising Medical Solutions

. Coordinate care for injured or disabled individuals, including high-risk, high-cost, and complex cases .

Posted 11/3/2026full-timeRemote • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in case management, including assessment, coordination, and implementation of individualized care plans for injured or disabled individuals. Proficient in managing complex cases within the Workers' Compensation framework while ensuring compliance with relevant standards and regulations.

Highest-signal resume keywords

RN LicenseCase Management ExperienceWorkers' Compensation KnowledgeUtilization ManagementMedical Bill Review Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCare Plan ImplementationData CompilationDocumentation ManagementInjury Severity AssessmentReturn-To-Work Strategy DevelopmentCase Management Activity TrackingFunctional Abilities AssessmentTelephonic Case ManagementCrisis Management

Soft Skills

Interpersonal SkillsConflict ResolutionTime ManagementOrganizational SkillsCustomer Service Orientation

Tools & Technologies

Microsoft SuiteRising SystemsClient Claims Systems

Certifications & Qualifications

RN LicenseCCM Certification

Industry Keywords

Workers' CompensationDisability ClaimsUtilization ManagementHealthcare ContinuumAccreditation Standards

About the role

Key responsibilities & impact

Coordinate care for injured or disabled individuals, including high-risk, high-cost, and complex cases
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
Assess, coordinate, implement, monitor, and evaluate individualized care plans
Promote quality, cost-effective care across the healthcare continuum
Support optimal function and safe, timely return to work when appropriate
Assess injury severity, disability, treatment plans, functional abilities, and physical job requirements
Develop return-to-work strategies and help manage future medical exposure
Track and report case management activity
Maintain organized, timely, and accurate clinical documentation
Respond to written and telephonic case-status inquiries
Document relevant case information in Rising systems and client claims systems when applicable
Follow applicable state, national, accreditation, departmental, and client-specific standards, policies, procedures, and reporting requirements
Escalate clinical, operational, service, or compliance concerns to the appropriate supervisor
Assist with URAC accreditation activities and related policies and procedures
Provide professional nursing insight to Rising Medical Bill Analysis and other internal teams

Requirements

What you’ll need

Current, active, unrestricted RN license in primary residence state and 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.)
3-5 years of case management experience with 1-2 years of specific worker’s compensation NCM experience
Experience with Workers’ Compensation, liability, or disability claims
Medical bill review experience with Workers’ Compensation, Auto, or Health Insurance carriers is preferred
Ability to maintain confidentiality of all information, policies, and procedures
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
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
Ability to stay calm during stressful situations
Having your CCM, and/or any other insurance/workers’ compensation certifications is a huge plus!
Professional Nursing degree (ASN, BSN)

Benefits

Comp & perks

Competitive base salary
Profit sharing
401k matching
Generous time off
Career growth opportunities
A relaxed, yet upbeat, work environment