Nurse Case Manager

Position 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.
• Safeguards 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.

Qualifications

• Ability and willingness to shift work schedule to a different time-zone as business dictates.
• Bachelor of Science in Nursing (BSN), Registered Nurse (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.

Benefits

The salary range for this position is $82,000 to 110,000/year; however, base pay offered will take into account a range of factors, including job-related knowledge, skills, and experience. The total compensation package includes a range of medical, dental, vision, financial, and other benefits, as well as equity.

About the Role

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.