Provides telehealth medication therapy management and wellness coaching for commercial and Medicare members. Conducts clinical outreach, coordinates care with members, prescribers, and pharmacy providers, and supports Medicare Part D and STAR ratings programs. Develops and updates clinical algorithms, call scripts, documentation standards, and outreach programs while educating clients, providers, and internal staff on MTM services and outcomes.
CompanyNavitus
About UsNavitus - 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._____________________________________________________________________________________________________________________________________________________________________________________________________________. 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 RangeUSD $71,716.18 - USD $86,405.04 /Yr.
STAR Bonus % (At Risk Maximum)7.50 - Salaried Non-Management except pharmacists
Work Schedule Description (e.g. M-F 8am to 5pm)M-Th 9am-5:30pm CT with 1 rotating shift of 10:30am-7pm CT & Fri 8:30am-5pm CT
Remote Work NotificationATTENTION: Navitus is only able to offer remote work to residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin.
Overview
The expected start timeframe for this position is January 2027 or later.
Our team is growing! We’re excited to be expanding our team with a new Telehealth RN Case Manager position. If you’re ready for a new challenge and an opportunity to use your nursing skills in a different way, check out the openings and take your next step with us!
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!
ResponsibilitiesHow 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
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!
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