Medical Management Nurse Lead - BioPlus Specialty Pharmacy

Medical Management Nurse Lead - BioPlus Specialty PharmacySign On Bonus: $5,000Schedule: Varied Shifts. May need to provide weekend/holiday support.Hybrid: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. BioPlus offer consumers and providers an unparalleled level of service that's easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer's treatment journey.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.How you will make an impact: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.Minimum 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.Preferred Skills, Capabilities, and Experiences:People management experience.Project management experience.BSN.Specialty Pharmacy experience.Bilingual.Drug Manufacturer experience.Telephonic Nursing experience.Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.