RN Case Manager, Telehealth

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

About Us

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.

Pay Range

USD $71,716.18 - USD $86,405.04 /Yr.

STAR Bonus % (At Risk Maximum)

7.50 - Salaried Non-Management except pharmacists

Work Schedule Description (e.g. M-F 8am To 5pm)

M-Th 9am-5:30pm CT with 1 rotating shift of 10:30am-7pm CT & Fri 8:30am-5pm CT

Remote Work Notification

ATTENTION: Navitus is only able to offer remote work to residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin.

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. 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.

Responsibilities

• 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

• 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!

Location : Address

Remote

Location : Country

US