The Telehealth Registered Nurse Case Manager (RN), Clinical Engagement Centerwill 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 RN is responsible for the delivery of the Medication Therapy Management (MTM) services for commercial and Medicare members. In addition, the RN will assist in the development and execution of additional clinical outreach program 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 for prescription, OTC, herbal and supplement medications. The assessment will include the development of a personalized Medication Action Plan in partnership with the member as required by CMS.
Additional responsibilities will be the provision of telehealth coaching to members in a variety of new program offerings aimed at improving adherence and driving to the lowest net cost formulary options. Remote engagement with members and prescribers will be frequent. The RN will also support the CEC’s Supervisor in development of appropriate clinical resources, recommendations regarding targeted medication review selections, and policies and procedures related to the CEC. Other support provided will include clinical oversight of pharmacy technicians, pharmacy interns, and products including reporting and audit support.
This position may be located in one of our offices in Appleton (WI), Madison (WI), Phoenix (AZ), Austin (TX), or fully remote.
- 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 outreach.
- Collaborate with other CEC staff to develop and maintain a high quality and consistent MTM product.
- Assist Supervisor 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 in order 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.
- Maintain open lines of communication with other functional areas/departments.
- Develop a full understanding of Navitus Clients’ member experience and how the engagement center contributes to improved health and wellness.
- Adhere to compliance and HIPAA regulations.
Essential Background Requirements:
- Registered Nurse with unrestricted licensure
- Minimum of two 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
- High level of self-awareness.
- Exceptional customer service orientation.
- Creative thinker who will challenge the norm.
- Strong leadership skills.
- Advanced written and oral communication skills.
- Excellent interpersonal skills.
- Ability to adjust presentation style and language based on the audience.
- Proven fact-based decision-making abilities.
- Ability to effectively prioritize and execute tasks in a high-pressure environment.
- Extensive experience working in a team-oriented, collaborative environment.
- Desire to continuously learn and improve oneself.
- Highly motivated and self-directed.
- Keen attention to detail.
- The ability to consistently interact cooperatively and respectfully with other employees