Remote RN Case Manager - Telehealth MTM

Navitus; Sacramento (CA); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/M-

Referral Bonus Program – up to $750

Job summary

Navitus seeks a Telehealth RN Case Manager to deliver MTM services for commercial and Medicare members through our Clinical Engagement Center. You will contribute to the success of tele-pharmacy and wellness coaching programs, developing clinical outreach that improves member health and care coordination.

Responsibilities include MTM delivery, algorithm development, and supporting STAR ratings initiatives, with a focus on staying current with guidelines and CMS requirements.

Qualifications

• Registered Nurse with unrestricted licensure.
• Two years clinical experience including direct consultation preferred.
• Experience as a member of a multi-disciplinary team is preferred.
• Knowledge of HIPAA regulations and healthcare privacy practices is preferred.

Responsibilities

• Conduct MTM and CMS-aligned clinical programs.
• Develop clinical algorithms, pathways, and call scripts to support MTM delivery.
• Review and update MTM algorithms and call scripts yearly.
• Develop documentation standards for all clinical outreaches.
• Support STAR ratings outreach and education to clients, prescribers, and internal staff.
• Provide Medicare Part D/C clinical, operational, and educational support and stay current with updates.

Skills

Registered Nurse

Clinical experience

Team-based care

HIPAA knowledge

Compliance

Education

RN license

Job description

Navitus seeks a Telehealth RN Case Manager to deliver MTM services for commercial and Medicare members through our Clinical Engagement Center. You will contribute to the success of tele-pharmacy and wellness coaching programs, developing clinical outreach that improves member health and care coordination.

Responsibilities include MTM delivery, algorithm development, and supporting STAR ratings initiatives, with a focus on staying current with guidelines and CMS requirements.