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Telehealth RN Case Manager - Remote - Telehealth

Company: Navitus
Location: Austin
Posted on: November 26, 2022

Job Description:

Telehealth RN Case Manager - RemotePharmacy Benefits Reinvented- As the industry's alternative pharmacy benefit manager (PBM), we're committed to making prescriptions more affordable for you and your members. Here at Navitus, our team members work in an environment that celebrates creativity, fosters diversity and encourages growth. We welcome new ideas and share a passion for excellence.

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.

The MTM program will include telephonic and/or video chat outreach with members to complete an analysis of a member's medication regimen. The assessment will include the development of a personalized Medication Action Plan in partnership with the member as required by the Centers for Medicare and Medicaid Services (CMS).

Additional responsibilities will be the provision of telehealth coaching to members in a variety of new program offerings aimed at improving adherence and driving to the lowest net cost formulary options. Remote engagement with members and prescribers will be frequent. The Telehealth RN will also support the CEC's leadership in development of appropriate clinical resources, recommendations regarding targeted medication review selections, and policies and procedures related to the CEC. Other support provided will include clinical oversight of certified pharmacy technicians, pharmacy/nurse interns, and products including reporting and audit support.

Is this you? Find out more below!

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.
* 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
* Maintain open lines of communication with other functional areas/departments
* Develop a full understanding of Navitus Clients' member experience and how the clinical engagement center contributes to improved health and wellness
* Adhere to compliance and HIPAA regulations

What our team expects from you?

* Registered Nurse with unrestricted licensure
* Minimum of two 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
* 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?

* Hours/Location: Monday - Thursday 8:00am-7:00pm CST, Friday 8:00am-5:00pm CST, Appleton WI, Madison WI, Phoenix AZ, Austin Tx or Remote
* Paid Volunteer Hours
* Educational Assistance Plan and Professional Membership assistance
* Referral Bonus Program - up to $750!
* Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Eight paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program

Keywords: Navitus, Austin , Telehealth RN Case Manager - Remote - Telehealth, Executive , Austin, Texas

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