Nurse Case Manager

MML US Inc•San Diego, CA

2h•$82,000 - $110,000

About The Position

Mainstay Medical is a medical device company focused on its ReActiv8® implantable neurostimulation system for people with disabling chronic mechanical low back pain. The Nurse Case Manager coordinates and oversees the process from patient identification through implantation. The role manages the ReActiv8® patient funnel, provides empathetic patient communication and education, and coordinates implant logistics to support a smooth path to implantation. Working closely with Therapy Managers and field-based teams, the Case Manager develops and manages patient action plans, monitors case progress, and provides timely, accurate updates and documentation in a web- or cloud-based system.

Requirements

BSN, RN, or equivalent required.
Experience in care coordination and case management, with some knowledge of insurance.
Experience in direct patient care in a medical office or hospital setting, including coding and prior authorization experience.
Knowledge of health insurance industry practices and functions, including Medicare, Medicaid, commercial coverage, and managed care organization policies.
Patient engagement and interaction skills, including experience in patient education.
Strong organizational skills and attention to detail.
Clear written and verbal communication skills, including in person, in writing, and over the phone.
Strong abilities with Microsoft Word, Outlook, Excel, and PowerPoint.
At least 3 years of experience working with a cloud- or web-based documentation system.
Strong problem-solving skills and ability to find solutions to challenges or process gaps.
A caring, empathetic, patient-centric approach in all interactions.
Ability and willingness to shift work schedule to a different time zone as business dictates.
Ability to travel up to 10% of the time.

Responsibilities

Serve as a subject matter expert on ReActiv8® and clinically review patient medical records, ensuring complete, high-quality case documentation for all levels of review.
Educate patients and family members about the ReActiv8® system and therapy, and explain the prior authorization process.
Work with Therapy Managers to oversee patient progress toward implantation, evaluate and navigate approval pathways, and make adjustments as needed.
Accurately document patient interactions and outcomes in a web- or cloud-based system.
Act as a liaison among physicians, office staff, patients, and field teams, providing empathetic customer service and timely case updates.
Advocate for patient needs and preferences while respecting confidentiality.
Coordinate communication among team members and facilitate regular pipeline calls to keep cases progressing.
Develop, implement, and manage an action plan for each patient in collaboration with the Therapy Manager and patient, documenting each plan.
Collaborate with internal and field teams to address patient barriers and align resources for the implant process.
Work with patients and care providers to facilitate access to surgical scheduling and ReActiv8® implantation.
Manage multiple priorities, deadlines, and a high patient volume.
Comply with company policies, particularly HIPAA patient confidentiality requirements.
Communicate effectively in person, in writing, by phone, and before small and mid-sized audiences.
Work independently and collaboratively, balancing workloads to prioritize patients.
Evaluate caseloads and use KPIs to identify and communicate insights and opportunities.
Shift work schedule across time zones as business needs dictate.
Assist Commercial Operations colleagues with patients or special projects as requested.