Registered Nurse, Telehealth

Navitus; Montpelier (VT); Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health benefits

Dental benefits

Vision benefits

20 days paid time off

4 weeks parental leave

9 paid holidays

401K match up to 5%

Adoption assistance

Flexible Spending Account

Educational assistance and membership

Referral bonus up to $750

Job summary

Navitus Health Solutions is hiring a Telehealth Registered Nurse to conduct telephonic comprehensive medication reviews and consultations, improving adherence and closing therapy gaps while ensuring CMS/HIPAA compliance.

You will collaborate with healthcare providers, clinics, and pharmacies to resolve patient concerns, support care coordination, and stay current with regulatory updates and clinical guidelines. This role offers remote work opportunities.

Qualifications

• High school diploma or GED required. BSN preferred.
• Current, unrestricted RN multi-state compact license in your state of residence. Willingness to obtain additional licensure.
• 3 years of clinical experience including direct consultation.
• Experience in a multi-disciplinary team preferred.
• PBM industry experience preferred.
• Motivational interviewing skills and behavior change experience preferred.
• Knowledge of privacy practices and HIPAA regulations preferred.
• HIPAA and healthcare regulations knowledge required.
• Chronic disease knowledge (diabetes, heart disease, COPD, etc.) required.
• English/Spanish bilingual preferred.
• Commitment to compliance program objectives.
• Ability to interact cooperatively with colleagues.

Responsibilities

• Conduct telephonic CMRs following CMS and HIPAA rules.
• Educate members on program benefits and adherence.
• Provide evidence-based clinical recommendations to improve outcomes.
• Perform telephonic medication consultations for adherence and insights.
• Assess member needs and propose clinical interventions.
• Apply clinical judgment and escalate non-routine cases.
• Support transitions of care with PMT guidance.
• Collaborate to maintain high-quality clinical services.
• Stay updated on program requirements and guidelines.
• Reach out to members/prescribers/pharmacies to address concerns.
• Coordinate with providers and pharmacies to resolve medication issues.
• Maintain knowledge of guidelines, medications, and best practices.
• Identify barriers to access and provide guidance on benefits.

Skills

Clinical experience

Motivational interviewing

HIPAA knowledge

Bilingual English/Spanish

Education

RN license (multi-state compact)

BSN preferred

Job description

Overview

The expected start timeframe for this position is January 2027 or later.

Our team is growing! We're excited to be expanding our team with a new Telehealth Registered Nurse position. If you're ready for a new challenge and an opportunity to use your nursing skills in a different way, check out the openings and take your next step with us!

The Registered Nurse, Telehealth is part of the Clinical Engagement Center (CEC) and conducts telephonic comprehensive medication reviews and consultations to improve patient adherence, close therapy gaps, and support clinical initiatives, all while ensuring compliance with CMS and HIPAA regulations.

The Registered Nurse, Telehealth will also collaborate with healthcare providers, clinics, and pharmacies to resolve patient concerns and enhance care coordination. Additionally, the Registered Nurse, Telehealth will stay current with regulatory updates and clinical guidelines.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Independently conduct routine telephonic comprehensive medication reviews (CMRs) in accordance with the Centers for Medicare & Medicaid Services (CMS), ensuring compliance with HIPAA and other regulatory standards.
• Educate members on program benefits and medication adherence applying routine clinical judgment within program protocols to identify risks, address, barriers and determine appropriate interventions.
• Provide optimal care through the delivery of evidence-based clinical recommendations to support improved health outcomes.
• Perform routine telephonic medication consultations to address member adherence, close therapy gaps, and assist with other clinical initiatives.
• Assess and interpret member needs to recommend appropriate clinical interventions.
• Ability to apply sound clinical judgment in well-defined situations and determine appropriate actions while escalating when non- routine situations when appropriate.
• Support members during transitions of care, including routine Personalized Member Transitions (PMT), by discussing alternative medications and coverage changes.
• Collaborate with team members to maintain consistent, high-quality clinical services.
• Stay informed on clinical program requirements and procedures to ensure compliance and quality.
• Conduct telephonic clinical outreach to members, prescribers, and pharmacies address patient concerns and enhance care coordination.
• Coordinate with providers, clinics, pharmacies, and members to resolve medication-related concerns and promote continuity of care.
• Maintain current knowledge of clinical practice guidelines, medications, and best practices to deliver accurate and effective recommendations.
• Identify and address barriers to medication access, providing guidance on benefits and available resources.
• Other duties as assigned.

Qualifications

What our team expects from you?

• High school diploma or GED required. BSN preferred.
• Current, unrestricted Registered Nurse multi-state compact license in the state of residence required. Willingness and ability to obtain additional state licensure where applicable.
• 3 years of clinical experience including direct consultation experience required.
• Experience as a member of a multi-disciplinary team preferred.
• Professional PBM industry work experience preferred.
• Experience and demonstrated competency in motivational interviewing techniques and facilitating behavior change preferred.
• Knowledge of applicable data privacy practices and laws preferred.
• Knowledge of healthcare industry practices and HIPAA regulations required.
• Knowledge of chronic disease states, such as diabetes, heart failure, COPD, asthma, cardiovascular disease, hypertension, and dyslipidemia required.
• Bilingual fluency in English and Spanish preferred.
• 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?

• 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!

#LI-Remote

Navitus Health Solutions is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by law.