RN Case Manager, Telehealth
United States
Company
NavitusAbout Us
Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other.Pay Range
USD $69,627.36 - USD $83,888.39 /Yr.Work Schedule Description (e.g. M-F 8am to 5pm)
Schedule would be either Monday -Thursday 10:30-7pm CT Friday 8:30-5pm CT or Monday -Thursday 10:00-7pm CT Friday 10:30-5pm CT CTRemote Work Notification
ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.Overview
Navitus Health Solutions is seeking a RN Case Manager, Telehealth to join our Clinical Engagement Center Clinical Operations department!
The Telehealth RN Case Manager will be a key contributor to the success of our Clinical Engagement Center focused on improving member’s health and wellness via tele-pharmacy and wellness coaching. This Telehealth RN is responsible for the delivery of the Medication Therapy Management (MTM) services for commercial and Medicare members. In addition, the Telehealth RN will assist in the development and execution of additional clinical outreach programs to exceed client expectations.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
- Conduct medication therapy management (MTM) and expanded clinical programs in accordance with the Centers for Medicare & Medicaid Services (CMS)
- Develop appropriate clinical algorithms, pathways, and call scripts to support pharmacy staff in delivering MTM services
- Review and update all algorithms and call scripts at least yearly and with updated clinical guidelines
- Develop documentation standards for all clinical outreaches
- Assist CEC leadership to develop program to support STAR ratings outreach
- Facilitate communication and education to clients, providers, and internal staff regarding MTM programs and program outcomes
- Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination
- Provide Medicare Part D clinical, operational, and educational support by maintaining knowledge of all existing updates and regulations regarding the MTM program and Medicare Part C and D performance measures (STAR ratings)
- Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into the MTM and STARs programs, such that our clinical outreaches remain up to date
- Other duties as assigned
Qualifications
What our team expects from you?
- Registered Nurse with unrestricted licensure
- Two years clinical experience including direct consultation experience 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
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
- 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
- Referral Bonus Program – up to $750!
#LI-Remote
Location : Address
RemoteLocation : Country
US ApplyJob Profile
Hawaii Maine Mississippi New Hampshire New Mexico No remote work in Alaska No remote work in Hawaii No remote work in Maine No remote work in Mississippi No remote work in New Hampshire No remote work in New Mexico No remote work in Rhode Island No remote work in South Carolina No remote work in South Dakota No remote work in West Virginia No remote work in Wyoming Rhode Island South Carolina South Dakota West Virginia Wyoming
Benefits/Perks20 days paid time off 401k company match 401(k) match 4 weeks 4 weeks paid parental leave 9 Paid Holidays Adoption Assistance Creativity Dental Dental Insurance Diversity Educational Assistance Flexible Spending Account Health Health insurance Paid holidays Paid parental leave Paid Time Off Parental leave Referral Bonus Remote work Vision Insurance
Tasks- Conduct medication therapy management
- Develop clinical algorithms and call scripts
- Develop documentation standards
- Facilitate communication
- Facilitate communication with clients and providers
- Integrate new guidelines into programs
- Maintain knowledge of CMS and Medicare regulations
- Provide clinical outreach and education
- Review and update clinical guidelines
- Support star ratings outreach
C Call Script Development Care Coordination Clinical Algorithms Clinical Consultation Clinical Documentation Clinical Guidelines Clinical operations Clinical Outreach Clinical Program Management Clinical programs CMS CMS regulations Coaching Communication Compliance Creativity Data privacy Data privacy laws Data privacy practices Documentation Health Healthcare Healthcare Industry Practices HIPAA HIPAA Compliance HIPAA regulations Insurance Leadership Medicaid Medicare Medicare Part C Medicare part d Medication review Medication therapy management MTM Multidisciplinary Team Outreach Patient Education Pharmacy Pharmacy operations Program development Regulatory Compliance Star ratings Telehealth Wellness coaching
Experience2 years
Certifications TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9