Telehealth RN Case Manager

🕒 6 days ago

🥔 Idaho – Remote

🥔 Idaho – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Develop appropriate clinical algorithms, pathways and call scripts to support pharmacy staff in delivering services. • Review and update all algorithms and call scripts at least yearly and with updated clinical guidelines. • Develop documentation standards for all clinical outreach. • Collaborate with department staff to develop and maintain a high quality and consistent product. • Facilitate communication and education to clients, providers, and internal staff regarding programs and program outcomes. • Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination. • Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into clinical programs and outreach efforts to ensure services remain up to date. • Maintain open lines of communication with other functional areas and departments. • Develop a full understanding of clients’ member experience and how engagement efforts contribute to improved health and wellness. • Adhere to compliance and HIPAA regulations. • Participate in, adhere to, and support compliance, people and culture, and learning programs. • Perform other duties as assigned.

🎯 Requirements

• Associate’s degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required; BSN preferred. • Current, active Registered Nurse (RN) license in good standing with the applicable State Board of Nursing is required. • 2+ years clinical experience including direct consultation experience. • Experience in a clinical call center is 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.

🏖️ Benefits

• 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