Telehealth RN Case Manager - Archimedes

Archimedes; Frankfort (KY); Hybrid; USD 85,000 - 125,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

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 and Pro. D

Job summary

Navitus Health Solutions is seeking an RN Case Manager, Telehealth to enhance member health through tele-pharmacy and clinical outreach programs. You will develop algorithms, support staff, and coordinate care with prescribers while staying current with guidelines.

The role can be based in St. Louis, MO or Brentwood, TN, or work remotely. Requires ADN/BSN and an active RN license, plus at least 2 years of clinical experience; PBM and HIPAA knowledge are preferred.

Qualifications

• Associate’s or Bachelor’s degree in nursing required; BSN preferred.
• Current active RN license in good standing.
• Minimum 2 years of clinical experience including direct consultation.
• Experience in a clinical call center is preferred.
• Experience as part of a multi-disciplinary team is preferred.
• Professional PBM industry work experience is preferred.
• Knowledge of data privacy practices and HIPAA regulations is preferred.

Responsibilities

• Develop clinical algorithms, pathways and call scripts to support staff.
• Review and update algorithms and call scripts yearly with updated guidelines.
• Develop documentation standards for all clinical outreach.
• Collaborate with staff to maintain high quality and consistency.
• Facilitate communication with clients, providers, and internal staff.
• Provide clinical outreach to members, prescribers, and providers.
• Stay current with guidelines and medications and integrate into programs.
• Maintain open lines of communication with other departments.
• Understand member experience and engagement impact on health.
• Adhere to compliance and HIPAA regulations.
• Participate in compliance, people and culture, and learning programs.
• Perform other duties as assigned.

Skills

Clinical experience

Call center experience

Team collaboration

HIPAA knowledge

Education

Associate’s degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required; BSN preferred.

Tools

PBM systems

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.

Equal employment opportunity, including veterans and individuals with disabilities.

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