[Hiring] Telehealth RN Case Manager @Navitus Health Solutions

Role Description

The RN Case Manager, Telehealth (RN) will focus on improving members’ health and wellness via tele-pharmacy. In addition, the RN will assist in the development and execution of additional clinical outreach program(s) to exceed client expectations.

• Provision of telehealth coaching to members in various new program offerings aimed at improving adherence and driving to the lowest net cost formulary options.
• Frequent remote engagement with members and prescribers.
• Support department leadership with development of appropriate clinical resources, recommendations regarding targeted medication review selections, and policies and procedures.
• Clinical oversight of pharmacy technicians, pharmacy interns, and products including reporting and audit support.

This role could be located out of our St Louis MO or Brentwood TN offices. We will consider remote associates as well.

Responsibilities

• Develop appropriate clinical algorithms, pathways, and call scripts to support pharmacy staff in delivering services.
• Review and update all algorithms and call scripts at least yearly and with updated clinical guidelines.
• Develop documentation standards for all clinical outreach.
• Collaborate with department staff to develop and maintain a high quality and consistent product.
• Facilitate communication and education to clients, providers, and internal staff regarding programs and program outcomes.
• Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination.
• Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into clinical programs and outreach efforts to ensure services remain up to date.
• Maintain open lines of communication with other functional areas and departments.
• Develop a full understanding of clients’ member experience and how engagement efforts contribute to improved health and wellness.
• Adhere to compliance and HIPAA regulations.
• Participate in, adhere to, and support compliance, people and culture, and learning programs.
• Perform other duties as assigned.

Qualifications

• Education: Associate’s degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required; BSN preferred.
• Certification/Licenses: Current, active Registered Nurse (RN) license in good standing with the applicable State Board of Nursing is required.
• Experience: 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.

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.