Remote RN Telehealth Case Manager – MTM Specialist

Navitus; Boston (MA); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

Holidays

401K match

Adoption assistance

Flexible Spending Account

Educational Assistance Plan

Professional Membership assistance

Referral Bonus Program

Job summary

Navitus Health Solutions seeks a Telehealth RN Case Manager to deliver MTM services for commercial and Medicare members through tele-pharmacy and wellness coaching. You will contribute to the development and execution of clinical outreach programs to exceed client expectations.

The role emphasizes MTM program delivery, collaboration with a multidisciplinary team, and ongoing script and guideline improvements to stay current with CMS requirements.

Qualifications

• Registered Nurse with unrestricted licensure.
• Two years clinical experience including direct consultation preferred.
• Experience in a multidisciplinary team is preferred.
• Professional PBM industry work experience is preferred.
• Knowledge of HIPAA regulations and healthcare industry practices.

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 annually with updated guidelines.
• Develop documentation standards for all clinical outreaches.
• Assist leadership to develop programs supporting STAR ratings outreach.
• Coordinate communication to clients, providers, and staff about MTM programs and outcomes.
• Provide Medicare Part D clinical, operational, and educational support and stay updated with regulations.

Skills

Registered Nurse

Team collaboration

Telehealth

Clinical outreach

Education

RN License

Job description

Navitus Health Solutions seeks a Telehealth RN Case Manager to deliver MTM services for commercial and Medicare members through tele-pharmacy and wellness coaching. You will contribute to the development and execution of clinical outreach programs to exceed client expectations.

The role emphasizes MTM program delivery, collaboration with a multidisciplinary team, and ongoing script and guideline improvements to stay current with CMS requirements.