The Clinical Case Manager will provide clinical and health policy expertise regarding payer coverage, and reimbursement. The Clinical Case Manager role is responsible to support the Reimbursement Hotline and be an advocate for patients to assist in securing coverage for Osiris Products. The ideal candidate will have an RN degree with 3+ years of clinical experience in a wound care center. The candidate must have comprehensive knowledge of reimbursement, coding, medical policies, treatment guidelines and billing for advanced wound therapies, including skin substitutes, in the HOPD and/or Physician office site(s) of care.
QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required: Registered Nurse, Wound Care Experience
Preferred: BSN or MSN preferred; Reimbursement Experience.
EDUCATION and/or EXPERIENCE
1 Wound Care experience
2 Knowledge of Medicare, Medicaid, and Private Insurer Reimbursement Methodology
3 Able to interpret and analyze detailed Medical policies
4 Basic understanding of the benefits investigation process [deductible, out of pocket, benefits exclusions, etc.]
5 Experience with the prior authorization process for products/services
6 Ability to communicate effectively both orally and in writing
7 Adept at handling sensitive and confidential situations
8 Ability to multi-task & adapt to changing priorities
9 Strong interpersonal skills
10 Strong analytical skills
11 Strong organizational skills; attention to detail
12 Ability to resolve associate issues quickly and efficiently
13 Ability to represent a positive and professional image
14 Strong knowledge of Microsoft Word, Excel, Power Point and Outlook
Osiris Therapeutics, Inc. is an Equal Opportunity Employer with a commitment to diversity. Applicants are considered on the basis of individual merit without regard to race, color, national or ethnic origin, gender, gender identity, sexual orientation, marital status, veteran status, pregnancy, age, religion, disability, genetic information, or any other characteristic protected by law.