Remote Telehealth RN Case Manager for MTM

Navitus; Raleigh (NC); Remote; USD 80,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

PTO 20 days

Parental leave 4 weeks

Holidays 9

401K match 5%

Adoption assistance

FSA

Education assistance

Membership assistance

Referral bonus $750

Job summary

Navitus Health Solutions seeks a Telehealth RN Case Manager to deliver MTM services for commercial and Medicare members. The role focuses on expanding MTM programs, improving care coordination, and supporting STAR ratings outreach through clinical engagement.

The position requires an unrestricted RN license, 2 years of clinical experience, and ability to work in a multidisciplinary team. Telehealth and remote collaboration are key aspects of the role.

Qualifications

• Unrestricted RN licensure is required.
• 2 years of clinical experience preferred.
• Experience on multi-disciplinary teams beneficial.
• PBM industry experience preferred.
• Knowledge of HIPAA and healthcare privacy practices.
• Understanding of healthcare industry practices.

Responsibilities

• Conduct MTM and CMS-aligned clinical programs.
• Develop MTM algorithms, pathways, and call scripts for MTM delivery.
• Review and update all algorithms and call scripts yearly.
• Develop documentation standards for clinical outreaches.
• Assist leadership to develop programs supporting STAR ratings outreach.
• Facilitate communication with clients, providers, and internal staff about MTM programs and outcomes.
• Provide Medicare Part D clinical and educational support and stay updated on regulations.
• Stay current with guidelines and medications to keep MTM programs up to date.
• Other duties as assigned.

Skills

RN licensure

Clinical experience

Team collaboration

HIPAA knowledge

PBM experience (preferred)

Compliance awareness

Communication skills

Education

Nursing license

Job description

Navitus Health Solutions seeks a Telehealth RN Case Manager to deliver MTM services for commercial and Medicare members. The role focuses on expanding MTM programs, improving care coordination, and supporting STAR ratings outreach through clinical engagement.

The position requires an unrestricted RN license, 2 years of clinical experience, and ability to work in a multidisciplinary team. Telehealth and remote collaboration are key aspects of the role.