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.

Telephonic Case Management Services: