Remote RN Case Manager: Telehealth MTM & Medicare

Navitus; Denver (CO); Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Paid time off (PTO)

Parental leave

Paid holidays

401K match

Adoption assistance

FSA/Tuition assistance

Referral bonus

Job summary

Navitus is expanding its Telehealth RN Case Manager role to support the Clinical Engagement Center, focusing on MTM services for commercial and Medicare members. You will contribute to program development and outreach, aligning with CMS guidelines and STAR ratings objectives.

You will work remotely, coordinating with pharmacists and clinicians to enhance member health and wellness through tele-health coaching and clinical outreach, while staying current with evolving guidelines and regulations.

Qualifications

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

Responsibilities

• Conduct MTM and expanded clinical programs per CMS guidelines.
• Develop clinical algorithms, pathways, and scripts to support MTM delivery.
• Review and update MTM algorithms and scripts annually with updated guidelines.
• Develop documentation standards for all clinical outreaches.
• Assist leadership to develop programs to support STAR ratings outreach.
• Communicate with clients, providers, and staff regarding MTM programs and outcomes.
• Provide Medicare Part D clinical, operational, and educational support with updates and performance measures.

Skills

RN license

Clinical experience

Team collaboration

PBM exposure

HIPAA knowledge

Job description

Navitus is expanding its Telehealth RN Case Manager role to support the Clinical Engagement Center, focusing on MTM services for commercial and Medicare members. You will contribute to program development and outreach, aligning with CMS guidelines and STAR ratings objectives.

You will work remotely, coordinating with pharmacists and clinicians to enhance member health and wellness through tele-health coaching and clinical outreach, while staying current with evolving guidelines and regulations.