RN Case Manager, Telehealth

CompanyNavitusAbout 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 $69,627.00 - USD $83,888.00 /Yr.STAR Bonus % (At Risk Maximum)5.00 - Salaried Non-Management except pharmacistsWork Schedule Description (e.g. M-F 8am to 5pm)M-Th 9am-5:30pm CT, with 1 rotating 10:30am-7pm CT shift. F 8:30am-5pm CTRemote Work NotificationATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.OverviewNavitus Health Solutions is seeking a Telehealth RN Case Manager to join our team!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 servicesReview and update all algorithms and call scripts at least yearly and with updated clinical guidelinesDevelop documentation standards for all clinical outreachesAssist CEC leadership to develop program to support STAR ratings outreachFacilitate communication and education to clients, providers, and internal staff regarding MTM programs and program outcomesProvide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordinationProvide 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 dateOther duties as assignedQualificationsWhat our team expects from you? Registered Nurse with unrestricted licensureTwo years clinical experience including direct consultation experience preferredExperience as a member of a multi-disciplinary team is preferredProfessional PBM industry work experience is preferredKnowledge of applicable data privacy practices and laws is preferredKnowledge of healthcare industry practices and HIPAA regulationsParticipate in, adhere to, and support compliance program objectivesThe ability to consistently interact cooperatively and respectfully with other employeesWhat can you expect from Navitus? Top of the industry benefits for Health, Dental, and Vision insurance20 days paid time off4 weeks paid parental leave9 paid holidays401K company match of up to 5% - No vesting requirementAdoption Assistance ProgramFlexible Spending AccountEducational Assistance Plan and Professional Membership assistanceReferral Bonus Program – up to $750! Location : AddressRemoteLocation : CountryUSOriginally posted on Himalayas