Telehealth RN Case Manager

🕒 il y a 13 jours

🥔 Idaho – Distant

🥔 Idaho – Remote

⏰ Temps Plein

🟢 Junior

🟡 Intermédiaire

👔 Manager

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Navitus Health Solutions

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 2003

⚕️ Assurance santé

💊 Pharmaceutique

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions est un gestionnaire de prestations pharmaceutiques (PBM) qui propose des solutions transparentes et centrées sur les personnes pour les prestations pharmaceutiques, à destination des régimes de santé, des employeurs, des programmes gouvernementaux et d'autres parrains de régimes. L'entreprise opère sur un modèle de passage intégral à un coût majoré, qui met l'accent sur la réduction des coûts des médicaments, la gestion des formulaires, la gestion des médicaments spécialisés (y compris une pharmacie spécialisée à coût majoré), l'évaluation des réclamations, la gestion du réseau de pharmacies, ainsi que l'activation et le support des membres. Navitus se positionne comme un partenaire fiduciaire axé sur l'accessibilité, la conformité, la qualité clinique, et l'amélioration des résultats de santé grâce à des services PBM sur mesure et à des intégrations de santé numérique.

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.

🎯 Exigences

• 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.

🏖️ Avantages

• 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