RN Case Manager, Telehealth, Nationwide

2025-5397 Company Navitus About Us Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at to be considered for internal opportunities. Pay Range USD $69,627.00 - USD $83,888.00 /Yr. STAR Bonus % (At Risk Maximum) 5.00 - Salaried Non-Management except pharmacists Work Schedule Description (e.g. M-F 8am to 5pm) M-TH 9-5:30CT, F 8:30-5CT with once weekly rotating 10:30-7:00CT pm shift Remote Work Notification ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Overview Navitus Health Solutions is seeking a Telehealth RN Case Manager to join our team! The Telehealth RN Case Manager will be a key contributor to the success of our Clinical Engagement Center focused on improving member’s health and wellness via tele-pharmacy and wellness coaching. This Telehealth RN is responsible for the delivery of the Medication Therapy Management (MTM) services for commercial and Medicare members. In addition, the Telehealth RN will assist in the development and execution of additional clinical outreach programs to exceed client expectations. Is this you? Find out more below! Responsibilities How do I make an impact on my team? • 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 Qualifications What our team expects from you? • 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 What can you expect from Navitus? • 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! #LI-Remote Location : Address Remote Location : Country US Apply tot his job