Telehealth RN Case Manager

Job not on LinkedIn

🔥 3 minutes ago

🏈 Alabama, Colorado, +17 more states – Remote

🏈 Alabama – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Improve members’ health and wellness via tele-pharmacy • Assist in the development and execution of clinical outreach programs • Provide telehealth coaching to members to improve adherence and drive use of lowest net cost formulary options • Engage remotely with members and prescribers • Support development of clinical resources, targeted medication review recommendations, policies, and procedures • Provide clinical oversight of pharmacy technicians, pharmacy interns, and products • Support reporting and audits • Develop clinical algorithms, pathways, and call scripts for pharmacy staff • Review and update algorithms and call scripts at least annually and when clinical guidelines change • Develop documentation standards for clinical outreach • Collaborate with department staff to maintain a high-quality, consistent product • Facilitate communication and education for clients, providers, and internal staff regarding programs and outcomes • Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination • Stay current with guidelines, literature, recommendations, and medications and integrate updates into clinical programs • Maintain communication with other functional areas and departments • Adhere to compliance and HIPAA regulations • Participate in 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 • Monday – Friday 8 – 4:30pm schedule • Remote work available only to residents of Alabama, Colorado, Florida, Georgia, Indiana, Illinois, Iowa, Kansas, Kentucky, Maryland, Minnesota, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin

🏖️ 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