RN Case Manager, Telehealth

🔥 0 minutes ago

🐻 Alaska, Hawaii, +11 more states – Remote

🐻 Alaska – Remote 🌺 Hawaii – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌾 North Dakota – Remote 🎸 Mississippi – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🦬 Wyoming – Remote

💵 $71.7k - $86.4k / year

⏰ 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

• 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 CEC leadership to develop program 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 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 • Other duties as assigned

🎯 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 is preferred • Participate in, adhere to, and support compliance program objectives • The ability to consistently interact cooperatively and respectfully with other employees

🏖️ 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!