Telehealth RN Case Manager - Archimedes

Navitus-Health-Solutions-Lumicera-Health-Services; St. Louis, Brentwood (MO, TN); Remote; USD 70,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Paid time off (20 days)

Parental leave (4 weeks)

9 holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational & Professional Memberships

Job summary

Archimedes is seeking an experienced RN Case Manager for Telehealth to improve member health via tele-pharmacy and to develop and drive clinical outreach programs. The RN will provide telehealth coaching, support program offerings, and coordinate with prescribers and pharmacy staff to optimize care and reduce net costs.

Remote engagement with members and prescribers will be frequent. This role could be located in St.

Qualifications

• ADN/BSN required; BSN preferred.
• Active RN license in good standing.
• 2+ years 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 preferred.

Responsibilities

• Develop clinical algorithms, pathways and call scripts for staff.
• Review and update algorithms and scripts yearly with guidelines.
• Develop documentation standards for outreach.
• Collaborate with staff to maintain high quality products.
• Facilitate communication with clients, providers and internal staff.
• Provide clinical outreach to members, prescribers and providers.
• Stay current with guidelines and medications; update programs accordingly.
• Maintain open communication with other departments.
• Understand client member experience and engagement impact.
• Adhere to compliance and HIPAA regulations.
• Participate in and support training and company programs.
• Perform other duties as assigned.

Job description

Company

Archimedes

About Us

Archimedes - Transforming the Specialty Drug Benefit - Archimedes is the industry leader in specialty drug management solutions. Founded with the goal of transforming the PBM industry to provide the necessary ingredients for the sustainability of the prescription drug benefit - alignment, value and transparency - Archimedes achieves superior results for clients by eliminating tightly held PBM conflicts of interest including drug spread, rebate retention and pharmacy ownership and delivering the most rigorous clinical management at the lowest net cost.

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 $0.00 - USD $0.00 /Yr.

STAR Bonus % (At Risk Maximum)

0.00 - Ineligible

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

Monday - Friday 8 - 4:30pm

Remote Work Notification

ATTENTION: Archimedes is only able to offer remote work to residents of Alabama, Colorado, Florida, Georgia, Indiana, Illinois, Iowa, Kansas, Kentucky, Maryland, Minnesota, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, Wisconsin.

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 or fully remote.

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?

• Associate’s degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required; BSN preferred.
• Current, active Registered Nurse (RN) license in good standing with the applicable State Board of Nursing is required.
• 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

#LI-Remote

Location : Address

Remote

Location : Country

US