Registered Nurse, Telehealth

Navitus; Springfield (IL); In loco; USD 70.000 - 95.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health insurance

Dental insurance

Vision insurance

PTO 20 days

Parental leave

9 holidays

401K match

Adoption assistance

Flexible Spending Account

Education assistance

Professional membership assistance

Referral bonus

Descrizione del lavoro

Navitus is seeking a Telehealth Registered Nurse to join the Clinical Engagement Center. The role focuses on telephonic comprehensive medication reviews to improve adherence and coordinate care across clinics, pharmacists, and providers.

The ideal candidate will have an RN license in a multi-state compact, 3 years of clinical experience, and knowledge of HIPAA and CMS guidelines. Bilingual English/Spanish is preferred. This position emphasizes regulatory compliance and patient-centered care.

Competenze

• High school diploma or GED required; RN license in home state; multi-state licensure preferred.
• 3 years of clinical experience including direct consultation.
• Experience on a multidisciplinary team recommended; PBM industry experience preferred.
• Knowledge of HIPAA, privacy practices, and CMS guidelines required.

Mansioni

• Independently conduct telephonic comprehensive medication reviews (CMRs) per CMS, ensuring HIPAA compliance.
• Educate members on benefits and adherence; identify risks and interventions.
• Provide clinical recommendations to improve health outcomes.
• Conduct telephonic medication consultations addressing adherence and therapy gaps.
• Assess member needs to suggest appropriate clinical interventions.
• Apply clinical judgment and escalate non-routine situations as needed.
• Support transitions of care and discuss medication coverage changes.
• Collaborate with team to maintain high-quality clinical services.
• Stay updated on clinical program requirements and procedures.
• Reach out telephonically to members, prescribers, and pharmacies to coordinate care.
• Coordinate with providers, clinics, pharmacies, and members to resolve medication-related concerns.
• Maintain knowledge of guidelines and best practices for accurate recommendations.
• Identify barriers to medication access and guide on benefits and resources.

Conoscenze

RN experience

Telehealth

Motivational interviewing

HIPAA knowledge

Teamwork

Formazione

RN license - multi-state compact

BSN preferred

Descrizione del lavoro

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!

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.