Telehealth RN Case Manager — MTM & Care Coordination

Navitus; Richmond (VA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision 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 and Pro/M"

Job summary

Navitus is seeking a Telehealth RN Case Manager to deliver MTM services for commercial and Medicare members through a telehealth model. You will develop programs, collaborate with pharmacy staff, and support STAR ratings outreach to improve member health and care coordination.

The role requires an RN with unrestricted licensure and clinical experience, with a preference for PBM exposure and HIPAA compliance knowledge, in a collaborative, outcomes-focused team.

Qualifications

• RN with unrestricted licensure
• Two years clinical experience including direct consultation preferred
• Experience in a multi-disciplinary team is preferred
• PBM industry knowledge preferred
• HIPAA and privacy regulations knowledge preferred
• Ability to collaborate respectfully with other staff

Responsibilities

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

Skills

Registered Nurse licensure (RN)

Clinical experience

Team collaboration

HIPAA knowledge

PBM industry knowledge

Education

RN license

Job description

Navitus is seeking a Telehealth RN Case Manager to deliver MTM services for commercial and Medicare members through a telehealth model. You will develop programs, collaborate with pharmacy staff, and support STAR ratings outreach to improve member health and care coordination.

The role requires an RN with unrestricted licensure and clinical experience, with a preference for PBM exposure and HIPAA compliance knowledge, in a collaborative, outcomes-focused team.