Madison Taylor
Kansas City,MO
Summary
Fertility Advocate and Clinical Team Lead at Aetna/CVS Health, showcasing a blend of maternity and infertility clinical experience, exceeding monthly productivity metrics by 25-35%, effective time management and team-mentorship. Proficient in medical records review related to infertility, eligibility criteria and verbiage, and committed to learning opportunities in Utilization Management to promote quality effectiveness of Healthcare Services.
Overview
10
10
years of professional experience
Work History
Fertility Advocate, Clinical Team Lead
Aetna/CVS Health
07.2022 - Current
- Single point and first line of contact for Maternity and Fertility Advocate staff for clinical issues.
- Weekly referral bucket assignments for Maternity CMs and monthly team call audit reviews.
- Current caseload average of 150 engaged members with monthly productivity average range of 105-115% (80% is metric).
- Internal and external program collaboration and referrals.
- Personalized member support from preconception, helping assist with fertility benefits, prior authorization, eligibility criteria, and ongoing educational support throughout maternity and postpartum journey.
- Utilization of clinical knowledge to assist members with understanding of CPB criteria, eligibility and exclusions, benefit plan coverage, CPT codes, claims, and prior authorization denials, approvals, and appeals processes
Maternity Nurse Case Manager
Aetna/CVS Health
02.2018 - 07.2022
- Dedicated Aetna One Advocate Team Case Manager for enhanced maternity members, exceeding all company metrics and productivity requirements while precepting and seeking additional tasks and skills.
- Presentation of case audits and maternity program to account teams and new hire staff for internal Aetna/CVS Health programs.
- Caseload average of 200 maternity members, assistance with inbound triage calls and daily inpatient referrals for same-day discharge planning outreaches.
- Strong self-organizational and time management skills to concurrently manage multiple cases while assisting staff and management efficiently.
Registered Nurse/Relief Charge Nurse
The University of Kansas Health Systems
07.2014 - 07.2020
- Staff nurse, preceptor, relief charge nurse on 29-bed maternity unit with full term nursery caring for high risk antepartum, couplets, post-operative gynecology, and newborn patients with weekly float rotation to NICU for 4 years
- 8:1 nurse to patient ratios with high acuity patients or 3:1 ratios with level 1-2 NICU patients while supporting fellow staff members and providing Magnet Status patient care.
- Collaboration with various hospital departments and families for maternal, newborn, and/or NICU discharge planning.
- EPIC Systems Super User, completion of one year nurse residency program, documentation of chart audit reviews, running unit mock code drills, and practice council committees to improve patient safety.
Education
Bachelor of Science - Nursing
William Jewell College
Liberty, MO05.2014
Skills
- Medical Records/Clinicals Review
- Infertility CPB review and understanding
- Team Collaboration and support
- Technological proficiency in CEC, MedCompass, CCI, PSPPS, PST, AetNet, ATV, and Client Care Access (CCA)
- Effective time management and self-motivation
- Attention to Detail
- Effective Communication
Active Licensure
Compact Registered Nurse licensure with active licensure in all 50 states
Timeline
Fertility Advocate, Clinical Team Lead
Aetna/CVS Health
07.2022 - Current
Maternity Nurse Case Manager
Aetna/CVS Health
02.2018 - 07.2022
Registered Nurse/Relief Charge Nurse
The University of Kansas Health Systems
07.2014 - 07.2020
Bachelor of Science - Nursing
William Jewell College
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