Remote RN Case Manager, Telehealth MTM Specialist

Navitus; Hartford (CT); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Paid holidays

401K match

Adoption assistance

Flexible Spending Account

Educational assistance

Referral bonus $750

Job summary

Navitus Health Solutions is expanding its Clinical Engagement Center with a Telehealth RN Case Manager role starting January 2027 or later. The RN will deliver MTM services for commercial and Medicare members, and contribute to additional clinical outreach programs to improve member health and wellness via tele-pharmacy and coaching.

You will collaborate with a multidisciplinary team, develop clinical algorithms and call scripts, ensure CMS guidelines and HIPAA compliance, and help enhance STAR

Qualifications

• RN with unrestricted licensure.
• Two years clinical experience including direct consultation preferred.
• Experience as a member of a multi-disciplinary team is preferred.

Responsibilities

• Conduct MTM and expanded clinical programs in accordance with CMS.
• Develop MTM 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 updates and regulations regarding MTM and STAR measures.
• Stay current with new guidelines and medications, and integrate that information into MTM and STAR programs.

Skills

RN license

Clinical experience

MTM knowledge

CMS guidelines

HIPAA knowledge

Education

Nursing degree

Job description

Navitus Health Solutions is expanding its Clinical Engagement Center with a Telehealth RN Case Manager role starting January 2027 or later. The RN will deliver MTM services for commercial and Medicare members, and contribute to additional clinical outreach programs to improve member health and wellness via tele-pharmacy and coaching.

You will collaborate with a multidisciplinary team, develop clinical algorithms and call scripts, ensure CMS guidelines and HIPAA compliance, and help enhance STAR