Telehealth RN Case Manager

This is a fully remote position, open to applicants in Alabama, +18 more states.

📋 Description

• Enhance the health and wellness of members through tele-pharmacy services.

• Aid in the planning and implementation of clinical outreach initiatives.

• Deliver telehealth coaching to members to improve adherence and promote the use of the most cost-effective formulary options.

• Engage with members and prescribers through remote communication.

• Assist in the creation of clinical resources, targeted medication review suggestions, policies, and procedures.

• Provide clinical oversight for pharmacy technicians, pharmacy interns, and products.

• Support reporting and auditing processes.

• Develop clinical algorithms, pathways, and call scripts for pharmacy personnel.

• Review and revise algorithms and call scripts at least annually or when clinical guidelines are updated.

• Establish documentation standards for clinical outreach efforts.

• Collaborate with departmental staff to ensure a high-quality and consistent product.

• Facilitate communication and education for clients, providers, and internal staff regarding programs and outcomes.

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

• Stay updated with guidelines, literature, recommendations, and medications and incorporate changes into clinical programs.

• Maintain communication with other functional areas and departments.

• Comply with regulations and HIPAA standards.

• Participate in compliance, people and culture, and learning initiatives.

• Perform additional duties as assigned.

⛳️ Requirements

• An Associate’s degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) is required; BSN is preferred.

• A current, active Registered Nurse (RN) license in good standing with the relevant State Board of Nursing is mandatory.

• A minimum of 2 years of clinical experience, including direct consultation experience.

• Experience in a clinical call center setting is preferred.

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

• Professional experience in the PBM industry is preferred.

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

• Knowledge of healthcare industry practices and HIPAA regulations.

• Availability for a Monday – Friday schedule from 8 AM to 4:30 PM.

• Remote work is available only for residents of Alabama, Colorado, Florida, Georgia, Indiana, Illinois, Iowa, Kansas, Kentucky, Maryland, Minnesota, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin.

🏝️ Benefits

• Comprehensive industry-leading 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 Professional Membership support.