Medical Management Nurse Lead - BioPlus Specialty Pharmacy

Elevance Health•Lake Mary, FL

2d•Hybrid

About The Position

The Medical Management Nurse Lead at BioPlus Specialty Pharmacy serves as the team lead, coach, and technical resource for a team of Medical Management Nurses or Medical Management Clinicians while also performing the responsibilities of a Medical Management Nurse. The role contributes to hiring, promotion, and other job-progression decisions; works on special projects; helps craft, implement, and improve organizational policies; and serves as a subject matter expert and liaison to other business areas or as a representative on enterprise initiatives. This hybrid role is based at 3200 Lake Emma Rd., Suite 1000, Lake Mary, Florida. Associates are expected to work in the office one to two days per week. The schedule involves varied shifts and may require weekend or holiday support. Candidates must be within reasonable commuting distance unless an accommodation is granted as required by law. BioPlus Specialty Pharmacy, part of Elevance Health, provides specialty medication access and personalized support to consumers and providers. Elevance Health describes itself as a health company focused on improving lives and communities and making healthcare simpler. The position is classified as Non-Management Exempt.

Requirements

Minimum associate degree in nursing.
At least 6 years of care management or case management experience.
At least 2 years of clinical, utilization review, or managed care experience, or an equivalent combination of education and experience.
Current, active, valid, unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable U.S. state(s) or territory.
Multi-state licensure is required if providing services in multiple states.
Must be within reasonable commuting distance of the posting location unless an accommodation is granted as required by law.
New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and influenza unless they provide an acceptable explanation.

Nice To Haves

People management experience.
Project management experience.
Bachelor of Science in Nursing (BSN).
Specialty Pharmacy experience.
Bilingual skills.
Drug Manufacturer experience.
Telephonic Nursing experience.

Responsibilities

Identify the need for and drive execution of process or policy improvements.
Coordinate team members to ensure appropriate coverage.
Provide recommendations regarding hiring decisions and promotions.
Serve as a resource to lower-level nurses and clinicians.
Provide staff training and improve orientation and training materials.
Complete quality audits and help develop and implement corrective action plans.
Lead or participate in cross-functional teams, special projects, initiatives, and process-improvement activities.
Assist team members with review of challenging, complex, and overflow cases, as appropriate.
Work with healthcare providers to promote quality member outcomes, optimize member benefits, and encourage effective use of resources.
Consult with team members and Medical Directors to ensure medically appropriate, high-quality, cost-effective services.
Contribute to hiring, promotion, and other job-progression decisions for nurses on the team.
Serve as a subject matter expert and liaison to other business areas or represent the department on enterprise initiatives.
Perform the responsibilities of a Medical Management Nurse in addition to team-lead duties.