[Hiring] Registered Nurse, Telehealth @Navitus Health Solutions, LLC

Role Description

The expected start timeframe for this position is January 2027 or later.

Our team is growing! We’re excited to be expanding our team with a new Telehealth Registered Nurse position. If you’re ready for a new challenge and an opportunity to use your nursing skills in a different way, check out the openings and take your next step with us!

The Registered Nurse, Telehealth is part of the Clinical Engagement Center (CEC) and conducts telephonic comprehensive medication reviews and consultations to improve patient adherence, close therapy gaps, and support clinical initiatives, all while ensuring compliance with CMS and HIPAA regulations.

The Registered Nurse, Telehealth will also collaborate with healthcare providers, clinics, and pharmacies to resolve patient concerns and enhance care coordination. Additionally, the Registered Nurse, Telehealth will stay current with regulatory updates and clinical guidelines.

Responsibilities

• Independently conduct routine telephonic comprehensive medication reviews (CMRs) in accordance with the Centers for Medicare & Medicaid Services (CMS), ensuring compliance with HIPAA and other regulatory standards.
• Educate members on program benefits and medication adherence applying routine clinical judgment within program protocols to identify risks, address barriers and determine appropriate interventions.
• Provide optimal care through the delivery of evidence-based clinical recommendations to support improved health outcomes.
• Perform routine telephonic medication consultations to address member adherence, close therapy gaps, and assist with other clinical initiatives.
• Assess and interpret member needs to recommend appropriate clinical interventions.
• Ability to apply sound clinical judgment in well-defined situations and determine appropriate actions while escalating non-routine situations when appropriate.
• Support members during transitions of care, including routine Personalized Member Transitions (PMT), by discussing alternative medications and coverage changes.
• Collaborate with team members to maintain consistent, high-quality clinical services.
• Stay informed on clinical program requirements and procedures to ensure compliance and quality.
• Conduct telephonic clinical outreach to members, prescribers, and pharmacies to address patient concerns and enhance care coordination.
• Coordinate with providers, clinics, pharmacies, and members to resolve medication-related concerns and promote continuity of care.
• Maintain current knowledge of clinical practice guidelines, medications, and best practices to deliver accurate and effective recommendations.
• Identify and address barriers to medication access, providing guidance on benefits and available resources.
• Other duties as assigned.

Qualifications

• High school diploma or GED required. BSN preferred.
• Current, unrestricted Registered Nurse multi-state compact license in the state of residence required. Willingness and ability to obtain additional state licensure where applicable.
• 3 years of clinical experience including direct consultation experience required.
• Experience as a member of a multi-disciplinary team preferred.
• Professional PBM industry work experience preferred.
• Experience and demonstrated competency in motivational interviewing techniques and facilitating behavior change preferred.
• Knowledge of applicable data privacy practices and laws preferred.
• Knowledge of healthcare industry practices and HIPAA regulations required.
• Knowledge of chronic disease states, such as diabetes, heart failure, COPD, asthma, cardiovascular disease, hypertension, and dyslipidemia required.
• Bilingual fluency in English and Spanish 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!