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RN Care Manager in Greenwich, CT at Pride Health

Date Posted: 11/24/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Greenwich, CT
  • Experience:
    Not Specified
  • Date Posted:
    11/24/2018

Job Description

Care Manager

Manage the treatment plan utilization and care under the guidance of the Director, Clinical Services and Consulting Chief Medical Officer.  

Review clinical outcomes to determine appropriateness of care.
 

ESSENTIAL FUNCTIONS

Review medical treatments and approves care based on medical and contract guidelines.  

Reviews non-standard service outcomes and enters outcomes into the Tracking System (ATS) ensuring entry of all required information.

Review data entered by Customer Service Agents (CSA) to ensure accuracy and completeness.

Call patients to discuss care, clarify, augment and/or confirm accuracy of information received from providers to ensure appropriate care.

Ensure 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 Customer Service team.    

Thinks strategically 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 protocols are continually improving to meet or exceed ASRM guidelines.

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 the voluntary benefit (e.g. DTC) 
 

QUALIFICATIONS

Current nursing license.

Bachelor of Science preferred

Graduate of an accredited school of nursing with a minimum degree of Associates of Science.  

Must be licensed to practice as a registered nurse in the state of NY.

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.