The RoleOversees 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.
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.
- Posses 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.
Qualifications:- Ability and willingness to shift work schedule to a different time-zone as business dictates.
- Ability to travel up to 10% of the time.
- Education level: 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.
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.
