Telehealth RN Case Manager: MTM & Care (Remote)

Navitus; Saint Paul (MN); Remote; USD 86,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Paid holidays

401K company match

Adoption Assistance

Flexible Spending Account

Educational Assistance & Professional

Referral Bonus

Job summary

Navitus Health Solutions is expanding its Clinical Engagement Center and seeks a Telehealth RN Case Manager to drive MTM services for commercial and Medicare members. You will contribute to clinical outreach, program development, and care coordination through telehealth channels.

The role emphasizes staying current with CMS guidelines, MTM best practices, and collaboration with pharmacy staff, prescribers, and internal teams to exceed client expectations.

Qualifications

• RN with an unrestricted license in applicable state(s).
• Minimum two years of clinical experience, including direct consultation/work with patients.
• Experience in a multi-disciplinary team is preferred.
• Professional PBM industry experience is preferred.
• Knowledge of HIPAA and data privacy practices in healthcare.

Responsibilities

• Conduct MTM and expanded clinical programs in line with CMS guidelines.
• Develop clinical algorithms, pathways, and call scripts for MTM delivery.
• Review and update MTM algorithms and scripts annually with updated guidelines.
• Develop documentation standards for clinical outreaches.
• Assist leadership to develop programs supporting STAR ratings outreach.
• Facilitate communications with clients, providers, and internal staff on MTM outcomes.
• Provide Medicare Part D clinical and educational support and stay current with updates.

Skills

Registered Nurse

Unrestricted licensure

Clinical experience

PBM industry knowledge

Job description

Navitus Health Solutions is expanding its Clinical Engagement Center and seeks a Telehealth RN Case Manager to drive MTM services for commercial and Medicare members. You will contribute to clinical outreach, program development, and care coordination through telehealth channels.

The role emphasizes staying current with CMS guidelines, MTM best practices, and collaboration with pharmacy staff, prescribers, and internal teams to exceed client expectations.