Telehealth RN Case Manager - Archimedes

NHSHP; Concord (NH); Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Top industry benefits

Paid time off

Parental leave

401K match

Educational Assistance Plan

Job summary

Navitus Health Solutions is seeking an RN Case Manager, Telehealth (RN) to improve members' health and wellness through tele-pharmacy. The role involves developing and executing clinical outreach programs to exceed client expectations and guide formulary choices.

Remote engagement with members and prescribers is common, with oversight of pharmacy staff and resources, and collaboration with leadership to align on policies and procedures. HIPAA compliance is essential.

Qualifications

• RN license in good standing with state board is required.
• 2+ years clinical experience including direct consultation.
• Clinical call center experience preferred.
• Experience in a multidisciplinary team preferred.
• Knowledge of healthcare industry practices and HIPAA regulations.

Responsibilities

• Develop clinical algorithms, pathways and call scripts for pharmacy staff.
• Review/update algorithms and scripts annually with updated guidelines.
• Develop documentation standards for clinical outreach.
• Collaborate with staff to maintain a high quality, consistent product.
• Provide clinical outreach to members, prescribers and providers.
• Stay current with guidelines and medications and integrate into programs.
• Ensure compliance with HIPAA and related regulations.

Skills

Clinical consultation

HIPAA knowledge

Education

ADN / BSN required

BSN preferred

Tools

Electronic Health Records

Job description

Overview

The RN Case Manager, Telehealth (RN) will focus on improving members' health and wellness via tele-pharmacy. In addition, the RN will assist in the development and execution of additional clinical outreach program(s) to exceed client expectations.

Additional responsibilities will be the provision of telehealth coaching to members in a variety of new program offerings aimed at improving adherence and driving to the lowest net cost formulary options. Remote engagement with members and prescribers will be frequent. The RN will also support department leadership with development of appropriate clinical resources, recommendations regarding targeted medication review selections, and policies and procedures. Other support provided will include clinical oversight of pharmacy technicians, pharmacy interns, and products including reporting and audit support.

This role could be located out of our St Louis MO or Brentwood TN offices. We will consider remote associates as well.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Develop appropriate clinical algorithms, pathways and call scripts to support pharmacy staff in delivering services.
• Review and update all algorithms and call scripts at least yearly and with updated clinical guidelines.
• Develop documentation standards for all clinical outreach.
• Collaborate with department staff to develop and maintain a high quality and consistent product.
• Facilitate communication and education to clients, providers, and internal staff regarding programs and program outcomes.
• Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination.
• Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into clinical programs and outreach efforts to ensure services remain up to date.
• Maintain open lines of communication with other functional areas and departments.
• Develop a full understanding of clients' member experience and how engagement efforts contribute to improved health and wellness.
• Adhere to compliance and HIPAA regulations.
• Participate in, adhere to, and support compliance, people and culture, and learning programs.
• Perform other duties as assigned.

Qualifications

What our team expects from you?

• Education: Associate's degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required; BSN preferred.

• Certification/Licenses: Current, active Registered Nurse (RN) license in good standing with the applicable State Board of Nursing is required.

• Experience:
  • 2+ years clinical experience including direct consultation experience.
  • Experience in a clinical call center is 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.

What can you expect from Archimedes?

• 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

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.

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