You would be working for a nationally respected healthcare organization that specializes in IVF and partners with large healthcare insurers to manage their obstetric and infertility treatments for their managed care plan members, allowing innovative solutions in patient care for both reproductive medicine and infertility.
As an RN IVF Case Manager, you will guide patients during the infertility treatment process and will review medical treatments and review eligibility /approve care based on the organization’s medical and contract guidelines. You will be responsible for creating and managing an individualized plan of care for each patient, and will review all clinical outcomes in determining the appropriateness of care.
Work under the guidance of the Director/VP of Clinical Services and CMO in full collaboration of the IVF Care Management team.
- Review medical treatments and approve care based on company’s medical and contract guidelines.
- Create and manage individualized plans of care for all patients. Provide telephonic case management, education and support during the IVF treatment process for members including health plans. Call patients to discuss care or confirm accuracy of information received from providers to ensure appropriate care, as necessary.
- Review all clinical outcomes in determining the appropriateness of care. Review non-standard service outcomes and enter into the Authorization Tracking System ensuring entry of information.
- Ensure providers are informed of patient needs, treatment modification, and/or progress when necessary or requested.
- Handle complex issues or questions and troubleshoot clinical problems. Manage and consult with next level authority on rare cases.
- Reviews benefit status based on customer plans and eligibility file information prior to authorization of services or administrative/benefit denials.
- Bachelor’s degree in nursing.
- Current nursing license (and advanced practice license if applicable) and eligibility for licensure in additional states.
- Minimum of 2-3 years of experience in assisted reproductive technology including general infertility, IVF or infertility care management. 4-5 years or more preferred.
Phone: 860-278-5840 Ex. 226