Medical Management Nurse Lead - BioPlus Specialty Pharmacy
About The Position
The Medical Management Nurse Lead - BioPlus Specialty Pharmacy is responsible for serving as the team lead, coach, and technical resource for a team of either Medical Management Nurses or Medical Management Clinicians, in addition to the responsibilities of the Medical Management Nurse role. Contributes on hiring, promotion, and other job-progression decisions for the nurses on their team. Works on special projects and helps to craft, implement, and improve organizational policies. Serves as the subject matter expert and department liaison to other areas of the business unit or as the representative on enterprise initiatives.
Requirements
- Requires a minimum of associate’s degree in nursing.
- Requires a minimum of 6 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would provide an equivalent background.
- Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required.
- Multi-state licensure is required if this individual is providing services in multiple states.
Nice To Haves
- People management experience.
- Project management experience.
- BSN.
- Specialty Pharmacy experience.
- Bilingual.
- Drug Manufacturer experience.
- Telephonic Nursing experience.
Responsibilities
- Identifies the need for, and driving the execution of, process or policy improvements.
- Coordinates team members to ensure appropriate coverage.
- Provides valuable recommendations in hiring decisions, as well as promotions.
- Serves as a resource to lower-level nurses and clinicians.
- Provides training for staff.
- Improves materials used in orientation and training efforts.
- Completes quality audits and helps to develop and implement associated corrective action plans.
- Leads or participates on cross-functional teams, special projects, initiatives, and process improvement activities.
- Assists team members, as appropriate, with review of the most challenging and complex cases, as well as overflow cases.
- Works with healthcare providers to promote quality member outcomes, to optimize member benefits and promote effective use of resources.
- Consults with team members and Medical Directors to ensure medically appropriate, high-quality, cost-effective services.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
