RN Case Manager - Remote - Case Management

Company: Navitus
Location: Austin
Posted on: March 19, 2023

Job Description:

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 RN Case Manager, Clinical Engagement Center 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 RN is responsible for the delivery of the Medication Therapy Management (MTM) services for commercial and Medicare members. In addition, the RN will assist in the development and execution of additional clinical outreach program 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 for prescription, OTC, herbal and supplement medications. The assessment will include the development of a personalized Medication Action Plan in partnership with the member as required by CMS.

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.
* Develop documentation standards for all clinical outreach.
* Collaborate with other CEC staff to develop and maintain a high quality and consistent MTM product.
* Assist Supervisor 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 in order 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.

What our team expects from you?

* Registered Nurse with unrestricted licensure
* Spanish-speaking is preferred
* Minimum of two years clinical experience including direct consultation experience. Experience in a clinical call center is preferred
* Professional PBM industry work experience is preferred
* 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 - Friday: 8:30am-5:00pm CST, Appleton WI Office, Madison WI Office, Austin TX Office, Phoenix AZ Office 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 , RN Case Manager - Remote - Case Management, Executive , Austin, Texas