RN Case Manager, Telehealth

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. 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._____________________________________________________________________________________________________________________________________________________________________________________________________________. 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. STAR Bonus % (At Risk Maximum)

7.50 - Salaried Non-Management except pharmacists Work Schedule Description (e.g. M-Th 9am-5:30pm CT with 1 rotating shift of 10:30am-7pm CT & Fri 8:30am-5pm CT Remote Work Notification

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. The expected start timeframe for this position is January 2027 or later.

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.

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

Develop documentation standards for all clinical outreaches

Assist CEC leadership to develop program to support STAR ratings outreach

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

Registered Nurse with unrestricted licensure

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

Top of the industry benefits for Health, Dental, and Vision insurance

~9 paid holidays

~Adoption Assistance Program

~ Flexible Spending Account

~ Educational Assistance Plan and Professional Membership assistance

~ Referral Bonus Program – up to $750!



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