Delivering employee-centric, clinical guidance to improve financial and functional health results.
An intervention backed by research, proven by results
Not every claim needs a nurse case manager. But, for those that do, the impact clinical intervention has on claim outcomes and costs is significant. Large-scale industry research and Rising results have shown that nurse case management produces:
- 18% lower future medical costs¹
- 26% lower overall claim costs¹
- 15% faster returns to work¹,²
- 8:1 ROI for Rising’s telephonic case management (TCM) services
Continuous care monitoring and support, from referral to file closure
No matter when our nurses get involved – from early intervention to getting escalating cases back on track – Rising helps employees and patients reach optimal levels of wellness and functional capabilities by providing timely, appropriate, and cost-effective care management. Overall, customers rely on Rising to:
- Provide advocacy-based nurse oversight
- Identify high-quality providers and coordinate care
- Review treatment plans and drug regimens
- Monitor and address recovery risk factors throughout the claim lifecycle, including biopsychosocial issues
- Recommend timely, appropriate interventions
- Benchmark case to evidence-based treatment and disability duration guidelines
- Conduct ongoing, productive communication with all claim stakeholders
TCM + Bill Review, a powerful combination for improving outcomes
For customers who utilize Rising’s medical bill review services, there are additional program benefits:
- Evidence-based alerts for TCM intervention fueled by our customers’ claims and bill review data
- 1-click TCM referrals in our client web portal, with pre-population of claims data in form fields
- Medical records are already available to Rising, eliminating adjuster administrative involvement
- Existing data feedback loop can be used to measure TCM intervention effectiveness
¹ Helmsman Management Services. The N Factor: How Nurses Add Value to Workers Compensation Claims.
² URAC Case Management Performance Measurement: Aggregate Summary Performance Report.
