Nurse Jobs in San Diego, CA

About The Position

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.

Benefits

• Medical benefits
• Dental benefits
• Vision benefits
• Financial benefits
• Other benefits
• Equity