Nurse Case Manager

MML US Inc•San Diego, CA

3d•$82,000 - $110,000

About The Position

Mainstay Medical is a medical device company focused on marketing an innovative implantable neurostimulation system, ReActiv8®, for people with disabling chronic mechanical Low Back Pain. The company is headquartered in Dublin, Ireland, with subsidiaries operating in Ireland, the United States, Australia, Germany, and the Netherlands. The Role Oversees the coordination and execution from patient identification to implant. Case Managers are responsible for empathetic communication, education, and management of implant logistics for patients, ensuring a smooth and efficient path to implantation of ReActiv8®. Case Managers collaborate closely with field-based teams on patient pipelines. This individual will take ownership and manage the ReActiv8® patient funnel and provide timely and accurate updates to multiple team members. The incumbent will be a professional who demonstrates strong business acumen and collaborates effectively with field-based teams, providing timely, and accurate documentation in a web or cloud-based system.

Requirements

Ability and willingness to shift work schedule to a different time-zone as business dictates.
Ability to travel up to 10% of the time.
BSN, RN, or equivalent required.
Experience in care coordination, case management, and some knowledge of insurance- required.
Experience in direct patient care, in medical office or hospital setting with coding and prior authorization experience.
Knowledge of health insurance industry practices/functions to include Medicare, Medicaid, and all types of commercial and managed care organization’s coverage policies.
Skilled at patient engagement and interaction; experience in patient education.
Strong organizational skills with a keen eye and attention to detail.
Clear written and verbal communication skills—both in-person, in-writing and over the phone.
Strong abilities in Microsoft Word, Outlook, Excel, PowerPoint.
3+ years of experience working with a cloud or web-based documentation system required.
Strong problem solver and capable of finding solutions to challenges or process gaps.
Demonstrated interactions of maintaining a caring, empathetic, and patient-centric approach in all interactions.

Responsibilities

Acts as a subject matter expert on ReActiv8®, conducts clinical review of patient’s medical records, assuring complete and quality case documentation for all levels of review.
Provides education for patients and family members on the ReActiv8® system, therapy and the prior authorization process.
In conjunction with the Therapy Managers, will oversee patients progress to implant, navigating, evaluating and driving the most effective pathway to approval, while making necessary adjustments.
Possesses strong understanding on the need for patient documentation and will log all interactions and outcomes accurately within a cloud or web-based system.
Acts as a liaison between physicians, their office staff and patients, leveraging empathy, warmth and a customer service mindset in all interactions including field teams when providing timely case updates.
Advocates for patients needs and preferences, while always respecting patient confidentiality.
Facilitates communication and coordination amongst team members, facilitating regular pipeline calls to ensure cases are progressing forward towards pull through.
Develops, implements, and manages a plan of action for each patient in collaboration with the Therapy Manager (TM) and patient. Demonstrates strong documentation skills for each plan of action within a web or cloud-based system.
Regularly collaborates with team and field teams to ensure patient barriers are removed or addressed, and internal and external resources are aligned to facilitate the implant process.
Works with patients and care providers to ensure quick and easy access to surgical scheduling, and implantation of ReActiv8®.
Manages multiple priorities and deadlines simultaneously, while handling a high patient volume.
Ensures compliance with policies, in particular patient confidentiality (HIPAA) in all Mainstay Medical interactions.
Provides clear and effective communication via multiple methods (in-person, in-writing, on the phone and in front of small and mid-sized audiences).
Demonstrated ability to work independently as well as part of a team that values collaboration and openness while balancing workloads to ensure patients are always prioritized.
Strong acumen and desire to critically evaluate caseloads, bringing forward insights and opportunities via KPIs.
Ability and willingness to shift work schedule to a different time-zone as business dictates.
Willingness to assist others in Commercial Operations with patients and/or special projects as requested from both inside and outside the department.