Telehealth RN Case Manager - Archimedes

Navitus Health Solutions, LLC•,

1d•Remote

About The Position

The RN Case Manager, Telehealth focuses on improving members’ health and wellness through tele-pharmacy and other clinical outreach programs. The role provides telehealth coaching to members in programs designed to improve adherence and encourage use of the lowest net cost formulary options. It involves frequent remote engagement with members and prescribers and supporting department leadership with clinical resources, targeted medication review recommendations, policies and procedures, and clinical oversight of pharmacy technicians and interns. The role also supports products through reporting and audit activities. The position may be based in the St. Louis, Missouri or Brentwood, Tennessee offices, or performed fully remotely. Remote work is available only to residents of Alabama, Colorado, Florida, Georgia, Indiana, Illinois, Iowa, Kansas, Kentucky, Maryland, Minnesota, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m.

Requirements

Associate’s degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required.
Current, active Registered Nurse (RN) license in good standing with the applicable State Board of Nursing required.
At least 2 years of clinical experience, including direct consultation experience.
Knowledge of healthcare industry practices and HIPAA regulations.

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred.
Experience in a clinical call center preferred.
Experience as a member of a multidisciplinary team preferred.
Professional PBM industry work experience preferred.
Knowledge of applicable data privacy practices and laws preferred.

Responsibilities

Develop clinical algorithms, pathways, and call scripts to support pharmacy staff in delivering services.
Review and update algorithms and call scripts at least annually and when clinical guidelines change.
Develop documentation standards for clinical outreach.
Collaborate with department staff to develop and maintain a high-quality, consistent product.
Facilitate communication and education for clients, providers, and internal staff about programs and outcomes.
Conduct clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination.
Keep current with guidelines, literature, recommendations, and medications, and incorporate updates into clinical programs and outreach.
Maintain communication with other functional areas and departments.
Develop an understanding of clients’ member experience and how engagement efforts contribute to improved health and wellness.
Comply with compliance and HIPAA regulations.
Participate in and support compliance, people and culture, and learning programs.
Perform other duties as assigned.