Remote Telehealth RN Case Manager — MTM & Outreach

Navitus; Austin (TX); À distance; USD 85 000 - 105 000; Plein temps

Avantages offerts par ce poste

Health insurance

Dental and Vision insurance

Paid time off

Parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance

Flexible Spending Account

Educational Assistance

Referral Bonus up to $750

Résumé du poste

Navitus Health Solutions is expanding its Telehealth RN Case Manager team to deliver Medication Therapy Management (MTM) services for commercial and Medicare members via tele-pharmacy. This role focuses on improving member health and wellness and supporting program outreach and STAR ratings efforts.

The Telehealth RN will develop clinical algorithms and documentation standards, collaborate with pharmacy staff and providers, and stay current with CMS updates and Medicare Part C/D measures to

Qualifications

• RN licensure with unrestricted practice rights.
• 2 years clinical experience; direct consultation preferred.
• Experience in multidisciplinary teams preferred.
• PBM industry experience preferred.
• Knowledge of HIPAA and privacy regulations preferred.
• Ability to adhere to compliance program objectives.

Responsabilités

• Conduct MTM and CMS-aligned clinical programs.
• Develop clinical algorithms, pathways, and call scripts for MTM delivery.
• Review and update algorithms and call scripts yearly.
• Develop documentation standards for clinical outreaches.
• Assist leadership to develop STAR ratings outreach programs.
• Coordinate communication to clients, providers, and internal staff regarding MTM outcomes.
• Maintain knowledge of Medicare Part D, Part C, and STAR measures.
• Stay current with guidelines and medications and integrate into MTM programs.
• Other duties as assigned.

Connaissances

RN licensure

Clinical experience

PBM knowledge

HIPAA compliance

Team collaboration

Communication skills

Formation

RN degree (BSN/ADN)

Outils

MTM systems

Description du poste

Navitus Health Solutions is expanding its Telehealth RN Case Manager team to deliver Medication Therapy Management (MTM) services for commercial and Medicare members via tele-pharmacy. This role focuses on improving member health and wellness and supporting program outreach and STAR ratings efforts.

The Telehealth RN will develop clinical algorithms and documentation standards, collaborate with pharmacy staff and providers, and stay current with CMS updates and Medicare Part C/D measures to