RN Case Manager - Remote - Case Management
Company: Navitus
Location: Austin
Posted on: March 19, 2023
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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
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