RN Case Manager, Telehealth

Navitus; Austin (TX); Remote; USD 85,000 - 105,000; Full time

Benefits offered by this job

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

Job summary

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.

Responsibilities

• 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.

Skills

RN licensure

Clinical experience

PBM knowledge

HIPAA compliance

Team collaboration

Communication skills

Education

RN degree (BSN/ADN)

Tools

MTM systems

Job description

Overview

The expected start timeframe for this position is January 2027 or later.

Our team is growing! We’re excited to be expanding our team with a new Telehealth RN Case Manager position. If you’re ready for a new challenge and an opportunity to use your nursing skills in a different way, check out the openings and take your next step with us!

The Telehealth RN Case Manager will be a key contributor to the success of our Clinical Engagement Center focused on improving member’s health and wellness via tele-pharmacy and wellness coaching. This Telehealth RN is responsible for the delivery of the Medication Therapy Management (MTM) services for commercial and Medicare members. In addition, the Telehealth RN will assist in the development and execution of additional clinical outreach programs to exceed client expectations.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Conduct medication therapy management (MTM) and expanded clinical programs in accordance with the Centers for Medicare & Medicaid Services (CMS)
• Develop appropriate clinical algorithms, pathways, and call scripts to support pharmacy staff in delivering MTM services
• Review and update all algorithms and call scripts at least yearly and with updated clinical guidelines
• Develop documentation standards for all clinical outreaches
• Assist CEC leadership to develop program to support STAR ratings outreach
• Facilitate communication and education to clients, providers, and internal staff regarding MTM programs and program outcomes
• Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination
• Provide Medicare Part D clinical, operational, and educational support by maintaining knowledge of all existing updates and regulations regarding the MTM program and Medicare Part C and D performance measures (STAR ratings)
• Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into the MTM and STARs programs, such that our clinical outreaches remain up to date
• Other duties as assigned

Qualifications

What our team expects from you?

• Registered Nurse with unrestricted licensure
• Two years clinical experience including direct consultation experience preferred
• Experience as a member of a multi-disciplinary team is preferred
• Professional PBM industry work experience is preferred
• Knowledge of applicable data privacy practices and laws is preferred
• Knowledge of healthcare industry practices and HIPAA regulations
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!

#LI-Remote

Navitus Health Solutions is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by law.

Equal employment opportunity, including veterans and individuals with disabilities.