RN Case Manager, Telehealth
Navitus Health Solutions, LLC•,
•$71,716 - $86,405•Remote
About The Position
Navitus Health Solutions is seeking a Telehealth RN Case Manager to join their team. This role will be a key contributor to the success of the Clinical Engagement Center, focusing on improving member health and wellness through tele-pharmacy and wellness coaching. The Telehealth RN is responsible for delivering Medication Therapy Management (MTM) services for commercial and Medicare members. Additionally, the Telehealth RN will assist in the development and execution of additional clinical outreach programs to exceed client expectations.
Requirements
- Registered Nurse with unrestricted licensure
- Knowledge of healthcare industry practices and HIPAA regulations
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
Nice To Haves
- Two years clinical experience including direct consultation experience preferred
- Experience as a member of a multi-disciplinary team is preferred
- Professional PBM industry work experience is preferred
- Knowledge of applicable data privacy practices and laws is preferred
Responsibilities
- Conduct medication therapy management (MTM) and expanded clinical programs in accordance with the Centers for Medicare & Medicaid Services (CMS)
- Develop appropriate clinical algorithms, pathways, and call scripts to support pharmacy staff in delivering MTM services
- Review and update all algorithms and call scripts at least yearly and with updated clinical guidelines
- Develop documentation standards for all clinical outreaches
- Assist CEC leadership to develop program to support STAR ratings outreach
- Facilitate communication and education to clients, providers, and internal staff regarding MTM programs and program outcomes
- Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination
- Provide Medicare Part D clinical, operational, and educational support by maintaining knowledge of all existing updates and regulations regarding the MTM program and Medicare Part C and D performance measures (STAR ratings)
- Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into the MTM and STARs programs, such that our clinical outreaches remain up to date
- Other duties as assigned
Benefits
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5% - No vesting requirement
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
