- 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.
- Collaborate with other CEC staff to develop and maintain a high quality and consistent MTM product.
- Assist CEC leadership to develop program 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 all existing updates and regulations regarding the MTM program and Medicare Part C and D performance measures (STAR ratings).
- Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into the MTM and STARs programs, such that our clinical outreaches remain up to date.
- 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
- Hours/Location: Monday-Thursday 10:30am-7:00pm CST and Friday 8:30am-5:00pm CST, Remote
- Paid Volunteer Hours
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750
- Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Nine paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program
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RN Case Manager, Telehealth-Remote - Appleton, United States - Navitus
Description
Putting People First in Pharmacy- Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other.
We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
Are you tired of working nights, holidays, and weekends thus looking to leave bedside nursing? Are you ready to use your nursing experience to make an impact in people's lives? Do you value high quality care? Come join our growing team and enjoy the home-work life balance that is not easily obtained by nurses. This position may be fully remote or located at one of our offices in Appleton (WI), Madison (WI), Phoenix (AZ), Austin (TX).
The Telehealth RN Case Manager will be a key contributor to the success of our Clinical Engagement Center focused on improving member's health and wellness via tele-pharmacy and wellness coaching. This Telehealth RN is responsible for the delivery of the Medication Therapy Management (MTM) services for commercial and Medicare members. In addition, the Telehealth RN will assist in the development and execution of additional clinical outreach programs to exceed client expectations.
The MTM program will include telephonic and/or video chat outreach with members to complete an analysis of a member's medication regimen. The assessment will include the development of a personalized Medication Action Plan in partnership with the member as required by the Centers for Medicare and Medicaid Services (CMS).
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