Telehealth RN Case Manager - Archimedes

Archimedes; Des Moines (IA); Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Job summary

Archimedes is seeking an RN Case Manager for Telehealth to improve members’ health and wellness through tele-pharmacy and clinical outreach. You will develop and implement clinical resources, review medication review selections, and provide leadership oversight of technicians and interns.

You will engage remotely with members and prescribers, collaborate with teams, and stay current with guidelines to ensure programs meet client expectations.

Qualifications

• Active RN license in good standing.
• Associate degree in Nursing (ADN) or BSN required.
• 2+ years clinical experience.
• Experience in a clinical call center preferred.
• Experience as part of a multi-disciplinary team preferred.
• Knowledge of PBM industry preferred.

Responsibilities

• Develop clinical algorithms, pathways and scripts to support pharmacy staff.
• Review and update algorithms and scripts yearly with current guidelines.
• Develop documentation standards for clinical outreach.
• Coordinate with staff to maintain high-quality, consistent programs.
• Provide clinical outreach to members, prescribers and providers to enhance care coordination.
• Stay current with guidelines, literature and medications to keep programs updated.
• Maintain communication with other departments and understand member experience.
• Adhere to HIPAA regulations and compliance; support organizational learning programs.

Skills

RN license

Clinical experience

Clinical call center

PBM knowledge

Education

ADN or BSN

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.

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.

Equal employment opportunity, including veterans and individuals with disabilities.