Remote RN Case Manager - Telehealth MTM Specialist

Navitus; Madison (WI); On-site; USD 70,000 - 100,000; 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 Prof.‑

Referral Bonus up to $750

Job summary

Navitus Health Solutions is seeking a Telehealth RN Case Manager to drive Medication Therapy Management (MTM) and clinical outreach via tele-pharmacy and wellness coaching. You will work within our Clinical Engagement Center to enhance member health and program outcomes.

The role focuses on MTM delivery, CMS compliance, and cross-functional collaboration with providers and staff, with opportunities to support STAR ratings initiatives and expand telehealth services.

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.
• Professional PBM industry work experience is preferred.
• Knowledge of healthcare data privacy practices and HIPAA regulations preferred.

Responsibilities

• Conduct MTM and CMS-compliant clinical programs.
• Develop clinical algorithms, pathways, and call scripts to support MTM delivery.
• Review and update algorithms and scripts annually with updated guidelines.
• Develop documentation standards for all clinical outreaches.
• Assist leadership to develop programs supporting STAR ratings outreach.
• Facilitate communication to clients, providers, and staff regarding MTM outcomes.
• Provide Medicare Part D clinical, operational, and educational support and stay updated on regulations.

Skills

RN license

Clinical experience

Team collaboration

PBM knowledge

HIPAA knowledge

Job description

Navitus Health Solutions is seeking a Telehealth RN Case Manager to drive Medication Therapy Management (MTM) and clinical outreach via tele-pharmacy and wellness coaching. You will work within our Clinical Engagement Center to enhance member health and program outcomes.

The role focuses on MTM delivery, CMS compliance, and cross-functional collaboration with providers and staff, with opportunities to support STAR ratings initiatives and expand telehealth services.