Remote RN Case Manager - Telehealth MTM & Wellness

Navitus; Springfield (IL); Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health Insurance

20 days PTO

4 weeks parental leave

9 holidays

401K match up to 5%

Adoption Assistance

Flexible Spending Account

Educational & Membership support

Referral Bonus up to $750

Job summary

Navitus Health Solutions is seeking a Telehealth RN Case Manager to support the Clinical Engagement Center. You will deliver Medication Therapy Management (MTM) services to commercial and Medicare members via telehealth, and help expand clinical outreach programs to improve care coordination.

You will develop and update MTM algorithms and call scripts, educate providers and clients, and contribute to STAR ratings initiatives. A valid RN license and 2+ years of clinical experience are required.

Qualifications

• RN licensure in good standing.
• Two years of clinical experience, with direct consultation preferred.
• Experience in a multi-disciplinary team is preferred.
• PBM industry knowledge preferred.
• HIPAA and healthcare regulations familiarity.

Responsibilities

• Deliver MTM services in accordance with CMS guidelines.
• Develop algorithms, pathways, and call scripts to support MTM delivery.
• Review and update algorithms and scripts yearly with updated guidelines.
• Develop documentation standards for clinical outreaches.
• Assist leadership to develop programs supporting STAR ratings outreach.
• Facilitate communication to clients, providers, and staff regarding MTM programs and outcomes.
• Provide Medicare Part D/C guidance and STAR ratings updates.
• Stay current with guidelines and integrate new information into MTM/STAR programs.
• Other duties as assigned.

Skills

Clinical experience

Consultation skills

Team collaboration

PBM industry knowledge

Education

RN license (unrestricted)

Job description

Navitus Health Solutions is seeking a Telehealth RN Case Manager to support the Clinical Engagement Center. You will deliver Medication Therapy Management (MTM) services to commercial and Medicare members via telehealth, and help expand clinical outreach programs to improve care coordination.

You will develop and update MTM algorithms and call scripts, educate providers and clients, and contribute to STAR ratings initiatives. A valid RN license and 2+ years of clinical experience are required.