RN Case Manager, Telehealth

Navitus; Denver (CO); Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Paid time off (PTO)

Parental leave

Paid holidays

401K match

Adoption assistance

FSA/Tuition assistance

Referral bonus

Job summary

Navitus is expanding its Telehealth RN Case Manager role to support the Clinical Engagement Center, focusing on MTM services for commercial and Medicare members. You will contribute to program development and outreach, aligning with CMS guidelines and STAR ratings objectives.

You will work remotely, coordinating with pharmacists and clinicians to enhance member health and wellness through tele-health coaching and clinical outreach, while staying current with evolving guidelines and regulations.

Qualifications

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

Responsibilities

• Conduct MTM and expanded clinical programs per CMS guidelines.
• Develop clinical algorithms, pathways, and scripts to support MTM delivery.
• Review and update MTM algorithms and scripts annually with updated guidelines.
• Develop documentation standards for all clinical outreaches.
• Assist leadership to develop programs to support STAR ratings outreach.
• Communicate with clients, providers, and staff regarding MTM programs and outcomes.
• Provide Medicare Part D clinical, operational, and educational support with updates and performance measures.

Skills

RN license

Clinical experience

Team collaboration

PBM exposure

HIPAA knowledge

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,

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.

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