Telehealth RN Case Manager

Navitus Health Solutions

. Improve members’ health and wellness via tele-pharmacy .

Posted 10/27/2026full-timeRemote • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in tele-pharmacy and clinical outreach, providing telehealth coaching and clinical oversight while ensuring compliance with HIPAA regulations. Proficient in developing clinical resources and maintaining high-quality communication with members and healthcare providers.

Highest-signal resume keywords

Registered Nurse (RN) LicenseClinical ExperienceTelehealth CoachingClinical Outreach ProgramsHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Algorithms DevelopmentMedication Review RecommendationsDocumentation Standards DevelopmentCall Scripts DevelopmentData Privacy Practices Knowledge

Soft Skills

CommunicationCollaborationEducation Facilitation

Certifications & Qualifications

Associate’s Degree in Nursing (ADN)Bachelor of Science in Nursing (BSN)

Industry Keywords

Tele-PharmacyClinical Call CenterHealthcare Industry PracticesPharmacy Benefit Manager (PBM)Care Coordination

About the role

Key responsibilities & impact

Improve members’ health and wellness via tele-pharmacy
Assist in the development and execution of clinical outreach programs
Provide telehealth coaching to members to improve adherence and drive use of lowest net cost formulary options
Engage remotely with members and prescribers
Support development of clinical resources, targeted medication review recommendations, policies, and procedures
Provide clinical oversight of pharmacy technicians, pharmacy interns, and products
Support reporting and audits
Develop clinical algorithms, pathways, and call scripts for pharmacy staff
Review and update algorithms and call scripts at least annually and when clinical guidelines change
Develop documentation standards for clinical outreach
Collaborate with department staff to maintain a high-quality, consistent product
Facilitate communication and education for clients, providers, and internal staff regarding programs and outcomes
Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination
Stay current with guidelines, literature, recommendations, and medications and integrate updates into clinical programs
Maintain communication with other functional areas and departments
Adhere to compliance and HIPAA regulations
Participate in compliance, people and culture, and learning programs
Perform other duties as assigned

Requirements

What you’ll need

Associate’s degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required; BSN preferred
Current, active Registered Nurse (RN) license in good standing with the applicable State Board of Nursing is required
2+ years clinical experience including direct consultation experience
Experience in a clinical call center is 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
Monday – Friday 8 – 4:30pm schedule
Remote work available only to 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

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