Careers

Whether you’re already part of the WIN family, or simply eager to
learn more, we can’t wait to hear from you.

Care Manager, RN or LPN

SUMMARY

Responsible for managing treatment plan utilization and care under the guidance of the Director, Clinical Services and Consulting Chief Medical Officer.  Reviews clinical outcomes to determine appropriateness of care and ensure Company and contract obligations are met.

 

ESSENTIAL FUNCTIONS

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
  • 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 pathways, 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
  • Reviews benefit status based on customer plans and eligibility file information prior to authorization of services or administrative/benefit denials
  • Provide telephonic case management, education, and emotional support during the infertility treatment process for members’ health plans, employer groups or enrollee’s in our voluntary benefit (e.g. DTC)
  • Participates in cross functional teams and committees
  • May perform other duties as assigned

 

SUPERVISORY RESPONSIBILITIES

No direct supervisory responsibilities.

 

MINIMUM QUALIFICATIONS

  • 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
  • Minimum of five years’ experience in assisted reproductive technology including general infertility, IVF or infertility care management, or women’s health or a combination of infertility, case management  or quality management equal to five years of experience

KNOWLEDGE, SKILLS AND ABILITIES

  • Experience using MS Office products, including Word and Outlook
  • Bilingual Spanish desirable
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