RN Case Manager, Telehealth

Navitus; Washington (District of Columbia); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

PTO 20 days

Parental leave 4 weeks

9 paid holidays

401K match 5%

Adoption assistance

FSAs

Educational assistance

Professional membership assistance

Referral bonus up to $750

Job summary

Navitus Health Solutions is expanding its Telehealth RN Case Manager role to deliver MTM services to commercial and Medicare members. The position supports the Clinical Engagement Center and develops outreach programs to exceed client expectations.

You will work with pharmacy staff to implement MTM, stay current with CMS and HIPAA guidelines, and contribute to STAR ratings improvement through clinical outreach and education.

Qualifications

• RN with unrestricted licensure.
• Minimum 2 years clinical experience including direct consultation.
• Experience in multi-disciplinary teams preferred.
• PBM industry knowledge preferred.
• HIPAA regulations knowledge preferred.
• Ability to collaborate with clients, providers and staff.

Responsibilities

• Conduct MTM and expanded clinical programs per CMS guidelines.
• Develop clinical algorithms, pathways and call scripts for MTM delivery.
• Review/update algorithms and call scripts annually with updated guidelines.
• Develop documentation standards for clinical outreaches.
• Support STAR ratings outreach with leadership.
• Communicate MTM program outcomes to clients, providers and staff.
• Provide Medicare Part D clinical and educational support and stay updated on regulations.
• Stay current with new guidelines and integrate into MTM programs.

Skills

Registered Nurse

Clinical experience

Team collaboration

PBM industry knowledge

HIPAA/data privacy knowledge

Direct consultation experience

Education

Nursing licensure (unrestricted)

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.

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 holidays401K 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!

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.