Job Description

*SUMMARY*

Responsible for managing treatment plan utilizationand care under the guidance of the SVP and/ or Manager, Clinical Services and Consulting Chief Medical Officer. Reviews clinical records/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._
* Utilizes ATS for all points of service tracking and documentation
* Confirms member eligibility and IN Network Provider status prior to member engagement
* Confirm benefit details prior to member engagement
* Conducts scheduled and unscheduled consults with members and reviews medical treatment plans based on WIN’s medical and contract guidelines. Consults with Medical Director on unusual cases to determine appropriate referral.
* Encourages engagement in WIN App
* Provides care management to include provider navigation, plan of care, BH referrals, 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.
* Contributes to process improvement on process, the systems, telephone scripts, and educational elements
* Tracks trends, quality of care, protocols and pathways, quality of service reviews to ensure WIN’s protocols are continually improving to meet or exceed ASRM, AUA, and or SMRU guidelines.
* Contributes to reporting as needed
* 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). Must be licensed to practice as a registered nurse in the state of residence.
* Minimum of five years’ experience in subspecialty including general urology, infertility care management, men’s sexual health.

*KNOWLEDGE, SKILLS AND ABILITIES*
* Experience using MS Office products including Word and Outlook.
* Bilingual, Spanish or any other than English language desirable.

Job Type: Full-time

Benefits:
* 401(k)
* 401(k) matching
* Dental insurance
* Health insurance
* Paid time off
* Vision insurance
Medical Specialty:
* Reproductive Endocrinology & Infertility
* Urology

Experience:
* Urology Nursing: 5 years (Required)

Work Location: Remote

Job Tags

Full time, Contract work, Remote job,

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