Remote Telehealth RN Case Manager - MTM & Care Coordination

Navitus; Olympia (WA); Remote; USD 80,000 - 105,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Professional Membership assistance

Referral Bonus Program - up to $750

Job summary

Navitus Health Solutions seeks a Telehealth RN Case Manager to join our Clinical Engagement Center. The role centers on delivering MTM services for commercial and Medicare members through telehealth to improve health and wellness.

You will develop program content, documentation standards, and outreach initiatives while collaborating with pharmacy staff, prescribers, and clients. RN licensure and at least 2 years of clinical experience are required.

Qualifications

• RN with unrestricted licensure.
• Two years clinical experience including direct consultation preferred.
• Experience in a multi-disciplinary team and PBM industry preferred.
• Knowledge of data privacy practices and HIPAA regulations preferred.

Responsibilities

• Conduct MTM and expanded clinical programs in accordance with CMS.
• Develop algorithms, pathways, and call scripts to support MTM delivery.
• Review and update all algorithms and call scripts at least yearly with updated clinical guidelines.
• Develop documentation standards for all clinical outreaches.
• Assist leadership to develop programs supporting STAR ratings outreach.
• Facilitate communication and education to clients, providers, and internal staff regarding MTM programs and outcomes.
• Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination.
• Provide Medicare Part D clinical, operational, and educational support and stay updated on regulations (STAR ratings).
• Stay current with guidelines, literature, and medications and integrate into MTM and STAR programs.
• Other duties as assigned.

Skills

RN licensure

Clinical experience

Team collaboration

HIPAA knowledge

Job description

Navitus Health Solutions seeks a Telehealth RN Case Manager to join our Clinical Engagement Center. The role centers on delivering MTM services for commercial and Medicare members through telehealth to improve health and wellness.

You will develop program content, documentation standards, and outreach initiatives while collaborating with pharmacy staff, prescribers, and clients. RN licensure and at least 2 years of clinical experience are required.