RN Case Manager, Telehealth

This is a fully remote position, open to applicants in Alabama, +33 more states.

📋 Description

• Execute medication therapy management (MTM) and enhanced clinical programs in compliance with the Centers for Medicare & Medicaid Services (CMS).

• Create suitable clinical algorithms, pathways, and call scripts to aid pharmacy personnel in delivering MTM services.

• Review and refresh all algorithms and call scripts at least annually and in alignment with updated clinical guidelines.

• Establish documentation standards for all clinical outreach efforts.

• Support Clinical Engagement Center leadership in designing programs aimed at improving STAR ratings outreach.

• Enable communication and education for clients, providers, and internal team members about MTM programs and their outcomes.

• Conduct clinical outreach to members, prescribers, and pharmacy providers to improve care coordination.

• Offer clinical, operational, and educational assistance for Medicare Part D by keeping abreast of MTM program updates, regulations, and Medicare Part C and D performance metrics.

• Stay updated with new guidelines, literature, recommendations, and medications, incorporating them into MTM and STARs initiatives.

• Perform additional duties as assigned.

• Provide MTM services for both commercial and Medicare members while supporting further clinical outreach programs through tele-pharmacy and wellness coaching.

⛳️ Requirements

• Must be a Registered Nurse with an unrestricted license.

• Preferably have two years of clinical experience, including direct consultation experience.

• Experience working as part of a multi-disciplinary team is preferred.

• Prior professional experience in the PBM industry is favored.

• Familiarity with relevant data privacy practices and laws is preferred.

• Understanding of healthcare industry practices and HIPAA regulations.

• Must participate in, adhere to, and support compliance program objectives.

• Ability to consistently interact cooperatively and respectfully with other employees.

• Must reside in one of the approved states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, or Wisconsin.

• Must adhere to the specified schedule: Monday–Thursday 9:00am–5:30pm CT with one rotating 10:30am–7:00pm CT shift, and Friday 8:30am–5:00pm CT.

🏝️ Benefits

• Competitive benefits for Health, Dental, and Vision insurance.

• 20 days of paid time off.

• 4 weeks of paid parental leave.

• 9 paid holidays.

• 401K company match of up to 5% with no vesting requirement.

• Adoption Assistance Program.

• Flexible Spending Account.

• Educational Assistance Plan and support for Professional Memberships.

• Referral Bonus Program – up to $750!