FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
RN Case Manager, Telehealth
Navitus Health Solutions. Conduct medication therapy management (MTM) and expanded clinical programs in accordance with the Centers for Medicare & Medicaid Services (CMS) .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medication Therapy Management (MTM) and clinical program development, with a strong understanding of Medicare regulations and compliance. Capable of facilitating effective communication and education among clients, providers, and pharmacy staff to enhance care coordination and STAR ratings outreach.
Highest-signal resume keywords
Registered Nurse LicensureMedication Therapy Management (MTM)Clinical Program DevelopmentMedicare Part D KnowledgeHIPAA Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Algorithms DevelopmentCall Scripts CreationClinical OutreachCare CoordinationData Privacy Practices Knowledge
Soft Skills
Cooperative InteractionRespectful Communication
Tools & Technologies
Tele-PharmacyWellness Coaching
Industry Keywords
Centers for Medicare & Medicaid Services (CMS)STAR RatingsPharmacy Benefit Manager (PBM)Healthcare Industry Practices
About the role
Key responsibilities & impact- 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 outreaches
- Assist Clinical Engagement Center leadership in developing programs 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 to enhance care coordination
- Provide Medicare Part D clinical, operational, and educational support by maintaining knowledge of MTM program updates, regulations, and Medicare Part C and D performance measures
- Stay current with new guidelines, literature, recommendations, and medications and integrate them into MTM and STARs programs
- Perform other duties as assigned
- Deliver MTM services for commercial and Medicare members and support additional clinical outreach programs through tele-pharmacy and wellness coaching
Requirements
What you’ll need- Registered Nurse with unrestricted licensure
- Two years clinical experience including direct consultation experience preferred
- Experience as a member of a multi-disciplinary team is preferred
- Professional PBM industry work experience is preferred
- Knowledge of applicable data privacy practices and laws is preferred
- Knowledge of healthcare industry practices and HIPAA regulations
- Participate in, adhere to, and support compliance program objectives
- The 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 work the stated 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
Comp & perks- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5% - No vesting requirement
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!