[Hiring] Nurse Care Navigator @Point C

Role Description

The Nurse Care Navigator – Drug Optimization & Pharmacy Coordination is a licensed nurse responsible for coordinating and overseeing case management services related to medication optimization, international drug sourcing, and pharmacy benefit management (PBM) collaboration. This role serves as a clinical liaison among members, PBMs, international sourcing partners, providers, and internal teams to ensure safe, cost effective, and clinically appropriate medication use.

• Coordinate case management activities related to medication optimization, adherence, and therapeutic appropriateness
• Review medication regimens and clinical documentation to identify optimization opportunities
• Collaborate with providers, PBMs, and pharmacy partners to support evidence-based medication use and access
• Support specialty and high-cost medication coordination initiatives
• Coordinate international drug sourcing programs, including partner collaboration, member education, and continuity of care
• Serve as a clinical liaison across PBMs, pharmacy vendors, and internal teams to align on formulary options and access strategies
• Conduct member outreach, education, and follow-up to support adherence and understanding
• Review clinical records, pharmacy data, and provider documentation; escalate complex cases as needed
• Ensure compliance with nursing scope of practice, regulatory requirements, and organizational policies
• Maintain accurate and timely clinical documentation

Qualifications

• Active, unrestricted RN or LPN/LVN license (compact preferred, where applicable)
• Nursing degree or diploma from an accredited program
• 3–5+ years of experience in nursing, case management, care coordination, or a related clinical role
• Strong knowledge of pharmacology and medication management
• Experience collaborating across multiple stakeholders, including providers, PBMs, and pharmacy partners
• Experience in case management, PBMs, specialty pharmacy, or medication access programs preferred
• Familiarity with evidence-based guidelines (e.g., MCG, InterQual) preferred
• Experience in a TPA, managed care, or employer-sponsored health plan environment preferred
• Strong clinical judgment within scope of licensure
• Excellent communication skills and attention to detail, with a focus on accurate documentation
• Ability to coordinate member-focused care across cross-functional teams
• Working knowledge of regulatory and compliance requirements

Requirements

• Individual compensation will be commensurate with the candidate's experience and qualifications.
• Certain roles may be eligible for additional compensation, including bonuses, and merit increases.
• Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.
• Pay Transparency: $70,000 — $80,000 USD

Benefits

• Comprehensive medical, dental, vision, and life insurance coverage
• 401(k) retirement plan with employer match
• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
• Paid time off (PTO) and disability leave
• Employee Assistance Program (EAP)