Telehealth RN Case Manager - Archimedes

Responsibilities

• Develop appropriate clinical algorithms, pathways and call scripts to support pharmacy staff in delivering 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 department staff to develop and maintain a high quality and consistent product.
• Facilitate communication and education to clients, providers, and internal staff regarding programs and program outcomes.
• Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination.
• Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into clinical programs and outreach efforts to ensure services remain up to date.
• Maintain open lines of communication with other functional areas and departments.
• Develop a full understanding of clients’ member experience and how engagement efforts contribute to improved health and wellness.
• Adhere to compliance and HIPAA regulations.
• Participate in, adhere to, and support compliance, people and culture, and learning programs.
• Perform other duties as assigned.

Qualifications

• Education: Associate’s degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required; BSN preferred.
• Certification/Licenses: Current, active Registered Nurse (RN) license in good standing with the applicable State Board of Nursing is required.
• Experience: 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.