Telehealth RN Case Manager - Archimedes
About The Position
The RN Case Manager, Telehealth (RN) will focus on improving members’ health and wellness via tele-pharmacy. In addition, the RN will assist in the development and execution of additional clinical outreach program(s) to exceed client expectations. Additional responsibilities will be the provision of telehealth coaching to members in a variety of new program offerings aimed at improving adherence and driving to the lowest net cost formulary options. Remote engagement with members and prescribers will be frequent. The RN will also support department leadership with development of appropriate clinical resources, recommendations regarding targeted medication review selections, and policies and procedures. Other support provided will include clinical oversight of pharmacy technicians, pharmacy interns, and products including reporting and audit support. This role could be located out of our St Louis MO or Brentwood TN offices. We will consider remote associates as well.
Requirements
- Associate’s degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required; BSN preferred.
- Current, active Registered Nurse (RN) license in good standing with the applicable State Board of Nursing is required.
- 2+ years clinical experience including direct consultation experience.
- Knowledge of healthcare industry practices and HIPAA regulations.
Nice To Haves
- Experience in a clinical call center is 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
- Develop appropriate clinical algorithms, pathways and call scripts to support pharmacy staff in delivering services.
- Review and update all algorithms and call scripts at least yearly and with updated clinical guidelines.
- Develop documentation standards for all clinical outreach.
- Collaborate with department staff to develop and maintain a high quality and consistent product.
- Facilitate communication and education to clients, providers, and internal staff regarding programs and program outcomes.
- Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination.
- Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into clinical programs and outreach efforts to ensure services remain up to date.
- Maintain open lines of communication with other functional areas and departments.
- Develop a full understanding of clients’ member experience and how engagement efforts contribute to improved health and wellness.
- Adhere to compliance and HIPAA regulations.
- Participate in, adhere to, and support compliance, people and culture, and learning programs.
- Perform other duties as assigned.
Benefits
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
