Remote Telehealth RN Case Manager for MTM & Wellness

Navitus; Trenton (NJ); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Health benefits

Dental benefits

Vision benefits

Paid time off 20 days

Parental leave 4 weeks

9 paid holidays

401K match up to 5%

Adoption assistance

Flexible Spending Account

Education & professional membership

Job summary

Navitus Health Solutions is seeking a Telehealth RN Case Manager to lead MTM activities for commercial and Medicare members. This remote role supports the Clinical Engagement Center and collaborates with pharmacy staff to optimize patient outcomes.

The ideal candidate holds an unrestricted RN license, has 2+ years clinical experience, and can work within a multidisciplinary team while staying current on HIPAA and CMS guidelines. Navitus offers robust benefits and flexible telehealth options.

Qualifications

• Registered Nurse with unrestricted licensure.
• Two years clinical experience including direct consultation preferred.
• Experience in a multi-disciplinary team preferred.
• PBM industry experience preferred.
• Knowledge of HIPAA regulations preferred.
• Knowledge of data privacy practices preferred.
• Ability to participate in and support compliance program objectives.
• Ability to interact cooperatively with others.

Responsibilities

• Conduct MTM and expanded clinical programs per CMS guidelines.
• Develop clinical algorithms, pathways, and call scripts for MTM delivery.
• Review/update algorithms and scripts annually with new guidelines.
• Develop documentation standards for clinical outreaches.
• Assist leadership to support STAR ratings outreach programs.
• Communicate MTM program outcomes to clients, providers, and staff.
• Provide Medicare Part D/M TM program knowledge and regulatory updates.
• Stay current with new guidelines and integrate into MTM/STARs.

Skills

RN licensure

Clinical experience

Multidisciplinary team

PBM industry

HIPAA knowledge

Data privacy laws

Compliance programs

Professional conduct

Job description

Navitus Health Solutions is seeking a Telehealth RN Case Manager to lead MTM activities for commercial and Medicare members. This remote role supports the Clinical Engagement Center and collaborates with pharmacy staff to optimize patient outcomes.

The ideal candidate holds an unrestricted RN license, has 2+ years clinical experience, and can work within a multidisciplinary team while staying current on HIPAA and CMS guidelines. Navitus offers robust benefits and flexible telehealth options.