Medical Registered Nurse
White Plains, NY
Responsible for managing treatment plan utilization and care under the guidance of the Consulting Medical Director and Sr. Director, Clinical Services. Reviews clinical outcomes to determine appropriateness of care and ensure Company and contract obligations are met.
Critical features of this position are listed below and may be revised, updated or reassigned at management`s discretion in accordance with business needs or other factors.
`` Reviews medical treatments and approves care based on WIN`s medical and contract guidelines. Consults with Medical Director on unusual cases to determine appropriate action. Forwards Medical Cases to Medical Director as needed if unable to approve.
`` Reviews non-standard service outcomes and enters outcomes into the Authorization Tracking System (ATS) ensuring entry of all required information.
`` Reviews data entered into ATS by Customer Service Agents (CSA) to ensure accuracy and completeness.
`` Calls patients to discuss care, clarify, augment and/or confirm accuracy of information received from providers to ensure appropriate care, as necessary
`` Ensures providers are informed of patient needs, treatment modification, and/or progress when necessary or requested.
`` Handles complex clinical issues or questions and troubleshoots clinical problems for the CSA team.
`` Thinks strategically across the organization to improve processes and makes suggestions on improvements to the systems, telephone scripts, and processes.
`` Tracks ART trends, quality of care, protocols and guidelines, denial and appeal service reviews, and state mandates to ensure WIN`s protocols are continually improving to meet or exceed ASRM guidelines.
`` Utilizes knowledge of ATS, contract obligations, infertility, and best business practices to provide superior service to clients.
No direct supervisory responsibilities but provides oversight for the customer service department
`` Graduate of an accredited school of nursing with a minimum degree of Associates of Science. Bachelor of Science preferred
`` Current nursing license (and advanced practice license if applicable) in a state or territory of the United States, employment/practice and eligibility for licensure in additional states.
`` Minimum of two years` experience in assisted reproductive technology including general infertility, IVF or infertility care management, or women`s health.
KNOWLEDGE, SKILLS AND ABILITIES
`` Experience using MS Office products including Word and Outlook.
`` Bilingual Spanish desirable.