RN Case Manager, Telehealth

This is a fully remote position, open to applicants in Alaska, +12 more states.

📋 Description

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

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

• Review and revise all algorithms and call scripts annually and whenever there are updates to clinical guidelines.

• Establish documentation standards for all clinical outreach efforts.

• Collaborate with CEC leadership to design programs aimed at supporting STAR ratings outreach.

• Facilitate communication and provide education to clients, providers, and internal personnel regarding MTM initiatives and their outcomes.

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

• Offer clinical, operational, and educational support for Medicare Part D by staying informed about all current updates and regulations pertaining to the MTM program and Medicare Part C and D performance measures (STAR ratings).

• Remain updated on new guidelines, literature, recommendations, and medications, incorporating that knowledge into the MTM and STARs programs to ensure our clinical outreach remains current.

• Perform additional duties as assigned.

⛳️ Requirements

• Registered Nurse with full, unrestricted licensure.

• Minimum of two years clinical experience, ideally including direct consultation experience.

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

• Background in the PBM industry is preferred.

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

• Understanding of healthcare industry practices and HIPAA regulations is preferred.

• Commitment to participating in, adhering to, and supporting compliance program objectives.

• Ability to consistently interact in a cooperative and respectful manner with colleagues.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance benefits.

• 20 days of paid time off.

• 4 weeks of paid parental leave.

• 9 paid holidays.

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

• Adoption Assistance Program.

• Flexible Spending Account.

• Educational Assistance Plan and support for professional memberships.

• Referral Bonus Program offering up to $750!