Remote RN Telehealth Case Manager, MTM & Care Coordination

Navitus; Baton Rouge (LA); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

4 weeks paid parental leave

401K company match up to 5%

Adoption assistance

Flexible Spending Account

Education & Professional Memberships

Referral bonus up to $750

Job summary

Navitus is expanding its Telehealth RN Case Manager role to deliver MTM services for commercial and Medicare members via tele-health platforms. The position supports program development, outreach, and education across clients and providers, with a focus on care coordination and STAR ratings performance.

The role expects an RN with unrestricted licensure and solid clinical experience, able to work in a multi-disciplinary team. Navitus offers strong benefits and remote work options.

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 applicable data privacy practices and laws is preferred.
• Knowledge of healthcare industry practices and HIPAA regulations.

Responsibilities

• Conduct MTM and expanded clinical programs per CMS guidelines.
• Develop clinical algorithms, pathways, and call scripts for MTM delivery.
• Review and update algorithms and scripts yearly with updated guidelines.
• Develop documentation standards for all clinical outreaches.
• Assist leadership to develop programs supporting STAR ratings outreach.
• Provide clinical outreach to members, prescribers, and providers to improve care coordination.
• Stay current with guidelines and medications and integrate into MTM/STARs programs.

Skills

Registered Nurse

Clinical experience

Team collaboration

PBM industry

HIPAA knowledge

Healthcare privacy

Job description

Navitus is expanding its Telehealth RN Case Manager role to deliver MTM services for commercial and Medicare members via tele-health platforms. The position supports program development, outreach, and education across clients and providers, with a focus on care coordination and STAR ratings performance.

The role expects an RN with unrestricted licensure and solid clinical experience, able to work in a multi-disciplinary team. Navitus offers strong benefits and remote work options.