Remote Telehealth RN Case Manager | MTM & STAR Programs

Navitus Health Solutions; United States; Remote; USD 72,000 - 86,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

Parental leave (4 weeks)

9 paid holidays

401K company match (up to 5%)

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions is seeking a Telehealth RN Case Manager to join our Clinical Engagement Center. You will deliver Medication Therapy Management (MTM) services for commercial and Medicare members and contribute to tele-pharmacy and wellness coaching initiatives.

The position is slated for January 2027 or later, with remote work flexibility for qualified candidates. Navitus offers strong benefits, PTO, parental leave, holidays, and a 401(k) match, plus professional development support.

Qualifications

• Registered Nurse 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 privacy regulations (HIPAA) preferred.
• Knowledge of healthcare industry practices and HIPAA regulations.

Responsibilities

• Conduct MTM and expanded clinical programs per CMS guidelines.
• Develop clinical algorithms, pathways, and call scripts for MTM delivery.
• Review and update algorithms and scripts annually with updated guidelines.
• Develop documentation standards for all clinical outreaches.
• Support leadership to develop programs for STAR ratings outreach.
• Communicate MTM program outcomes to clients, providers, and staff.
• Provide Medicare Part D clinical and educational support and stay current with guidelines.
• Stay updated with new guidelines, literature, and medications to keep MTM programs current.
• Perform other duties as assigned.

Skills

Registered Nurse

Clinical experience

HIPAA knowledge

Team collaboration

Multi-disciplinary teamwork

Education

Nursing degree

Job description

Navitus Health Solutions is seeking a Telehealth RN Case Manager to join our Clinical Engagement Center. You will deliver Medication Therapy Management (MTM) services for commercial and Medicare members and contribute to tele-pharmacy and wellness coaching initiatives.

The position is slated for January 2027 or later, with remote work flexibility for qualified candidates. Navitus offers strong benefits, PTO, parental leave, holidays, and a 401(k) match, plus professional development support.