Remote RN Case Manager - Telehealth MTM & Wellness

Navitus; Dover (DE); À distance; USD 90 000 - 120 000; Plein temps

Avantages offerts par ce poste

Health, dental, and vision insurance

20 days PTO

Parental leave - 4 weeks

Résumé du poste

Navitus Health Solutions seeks a Telehealth RN Case Manager to join our Clinical Engagement Center. You will deliver MTM services to commercial and Medicare members and help develop outreach programs to improve health outcomes.

This role emphasizes collaboration with a multidisciplinary team, adherence to CMS and HIPAA requirements, and the creation of clinical algorithms, call scripts, and documentation standards to support STAR ratings and patient care across tele-pharmacy services.

Qualifications

• RN licensure in good standing
• 2+ years clinical experience preferred
• PBM industry knowledge encouraged
• Familiarity with HIPAA and healthcare privacy practices
• Strong teamwork and communication skills

Responsabilités

• Deliver MTM and CMS-aligned clinical programs to members
• Develop clinical algorithms, pathways, and call scripts for MTM delivery
• Review/update algorithms and scripts annually with new guidelines
• Create documentation standards for all clinical outreaches
• Assist leadership to develop STAR ratings outreach programs
• Coordinate with clients, providers, and internal staff to communicate MTM outcomes
• Provide Medicare Part D clinical/operational support and stay current on guidance

Connaissances

RN licensure

Clinical experience

PBM knowledge

HIPAA knowledge

Team collaboration

Formation

Nurse license (RN)

Description du poste

Navitus Health Solutions seeks a Telehealth RN Case Manager to join our Clinical Engagement Center. You will deliver MTM services to commercial and Medicare members and help develop outreach programs to improve health outcomes.

This role emphasizes collaboration with a multidisciplinary team, adherence to CMS and HIPAA requirements, and the creation of clinical algorithms, call scripts, and documentation standards to support STAR ratings and patient care across tele-pharmacy services.