RN Case Manager, Telehealth

Location US-

ID 2026-5624

Company

Navitus

About Us

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.

Pay Range

USD $69,627.00 - USD $83,888.00 /Yr.

STAR Bonus % (At Risk Maximum)

5.00 - Salaried Non-Management except pharmacists

Work Schedule Description (e.g. M-F 8am to 5pm)

M-Th 9am-5:30pm CT, with 1 rotating 10:30am-7pm CT shift. F 8:30am-5pm CT

Remote Work Notification

ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Overview

Navitus Health Solutions is seeking a Telehealth RN Case Manager to join our team!

The Telehealth RN Case Manager will be a key contributor to the success of our Clinical Engagement Center focused on improving member’s health and wellness via tele-pharmacy and wellness coaching. This Telehealth RN is responsible for the delivery of the Medication Therapy Management (MTM) services for commercial and Medicare members. In addition, the Telehealth RN will assist in the development and execution of additional clinical outreach programs to exceed client expectations.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

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

Qualifications

What our team expects from you?

Registered Nurse with unrestricted licensure
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
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

What can you expect from Navitus?