Fertility Nurse Care Advocate (Remote)

For more than 20 years, WIN has been managing family-building benefits that are delivered with care and support by the highest quality providers. WIN is the largest, most experienced fertility benefit management company in the country. It offers inclusive family-building solutions to employers, health plans and individual patients. From integrated fertility management, including medical treatment, pharmacy and reproductive genetics, to surrogacy and adoption, WIN’s mission is to help build families by providing access to the best network doctors, technology and emotional support at the lowest cost. WIN’s managed fertility programs include an integrated medical and pharmaceutical model that is unique to the industry. Its dedicated nurse care managers, all with experience in reproductive endocrinology clinics, guide employees through every step of their fertility journey, and are available 24/7.

FERTILITY Nurse Case Manager- Remote We are ONLY considering candidates with a minimum of five years’ experience in assisted reproductive technology including general infertility, IVF or infertility care management, or a combination of infertility, case management or quality management equal to five years of experience. NURSE CARE MANAGER POSITION 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.

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.