RN Case Manager, Telehealth
About The Position
Navitus is hiring a Telehealth RN Case Manager to support its Clinical Engagement Center, which works to improve members’ health and wellness through tele-pharmacy and wellness coaching. The role delivers Medication Therapy Management (MTM) services to commercial and Medicare members and helps develop and execute additional clinical outreach programs to exceed client expectations. The position is remote and available only to residents of the states and Washington, DC listed in the posting. The expected start timeframe is January 2027 or later. The schedule is Monday through Thursday, 9:00 a.m.–5:30 p.m. CT, with one rotating shift of 10:30 a.m.–7:00 p.m. CT, and Friday, 8:30 a.m.–5:00 p.m. CT.
Requirements
- Registered Nurse with unrestricted licensure.
- Knowledge of healthcare industry practices and HIPAA regulations.
- Participate in, adhere to, and support compliance program objectives.
- Ability to consistently interact cooperatively and respectfully with other employees.
Nice To Haves
- Two years of clinical experience, including direct consultation experience.
- Experience as a member of a multidisciplinary team.
- Professional PBM industry work experience.
- Knowledge of applicable data privacy practices and laws.
Responsibilities
- Conduct Medication Therapy Management (MTM) and expanded clinical programs in accordance with Centers for Medicare & Medicaid Services (CMS) requirements.
- Develop clinical algorithms, pathways, and call scripts to support pharmacy staff in delivering MTM services.
- Review and update algorithms and call scripts at least annually and when clinical guidelines are updated.
- Develop documentation standards for clinical outreach.
- Assist Clinical Engagement Center leadership in developing programs to support STAR ratings outreach.
- Facilitate communication and education for 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 staying informed about MTM program updates, regulations, and Medicare Part C and D performance measures (STAR ratings).
- Stay current with guidelines, literature, recommendations, and medications, and incorporate updates into MTM and STARs programs.
- Perform other duties as assigned.
Benefits
- Health, dental, and vision insurance.
- 20 days of paid time off.
- Four weeks of paid parental leave.
- Nine paid holidays.
- 401(k) company match of up to 5%, with no vesting requirement.
- Adoption Assistance Program.
- Flexible Spending Account.
- Educational Assistance Plan and professional membership assistance.
- Referral Bonus Program of up to $750.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
