Remote Telehealth RN Case Manager - MTM & Programs

Navitus; Oklahoma City (OK); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health, Dental, and Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/Mb

Referral Bonus Program – up to $750!

Job summary

Navitus Health Solutions is seeking a Telehealth RN Case Manager to join its Clinical Engagement Center in delivering MTM services to commercial and Medicare members through tele-pharmacy and wellness coaching. The role emphasizes clinical outreach, program development, and adherence to CMS guidelines.

The ideal candidate is an RN with unrestricted licensure, at least two years of clinical experience (preferably with multi-disciplinary teams and PBM industry familiarity), and strong HIPAA

Qualifications

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

Responsibilities

• Deliver MTM services via tele-pharmacy for commercial and Medicare members.
• Develop clinical algorithms, pathways, and call scripts for MTM delivery.
• Review and update MTM algorithms and scripts at least yearly with updated guidelines.
• Develop documentation standards for all clinical outreaches.
• Support STAR ratings outreach and program development with CEC leadership.
• Coordinate with clients, providers, and internal staff regarding MTM programs and outcomes.
• Provide Medicare Part D clinical, regulatory, and educational support for MTM and STAR measures.
• Stay current with guidelines and integrate new information into MTM and STAR programs.
• Perform other duties as assigned.

Job description

Navitus Health Solutions is seeking a Telehealth RN Case Manager to join its Clinical Engagement Center in delivering MTM services to commercial and Medicare members through tele-pharmacy and wellness coaching. The role emphasizes clinical outreach, program development, and adherence to CMS guidelines.

The ideal candidate is an RN with unrestricted licensure, at least two years of clinical experience (preferably with multi-disciplinary teams and PBM industry familiarity), and strong HIPAA