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 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
Other duties as assigned

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

RN Case Manager, Telehealth

Key skills