RN Case Manager, Telehealth

Job not on LinkedIn

🔥 2 minutes ago

🏈 Alabama, Arizona, +32 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $71.7k - $86.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

👻 Ghost score 0%

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

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

• 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 Clinical Engagement Center leadership in developing programs 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 MTM program updates, regulations, and Medicare Part C and D performance measures • Stay current with new guidelines, literature, recommendations, and medications and integrate them into MTM and STARs programs • Perform other duties as assigned • Deliver MTM services for commercial and Medicare members and support additional clinical outreach programs through tele-pharmacy and wellness coaching

🎯 Requirements

• 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 • Must reside in one of the approved states: 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, or Wisconsin • Must work the stated schedule: Monday–Thursday 9:00am–5:30pm CT with one rotating 10:30am–7:00pm CT shift, and Friday 8:30am–5:00pm CT

🏖️ 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 • Referral Bonus Program – up to $750!