Medical Management Nurse Lead - BioPlus Specialty Pharmacy

Elevance Health; Florida; Hybrid; USD 100.000 - 149.000; Vollzeit

Benefits dieser Stelle

Sign-On Bonus

Zusammenfassung

BioPlus Specialty Pharmacy, part of Elevance Health, seeks a Medical Management Nurse Lead to guide a team of nurses/clinicians, influence hiring and progression, and contribute to policy improvements. The role blends clinical leadership with organizational impact within a hybrid work model.

Ideal candidates hold an RN license with an associate degree plus extensive care management experience. Collaboration with medical directors and cross-functional teams is essential to optimize member

Qualifikationen

• Requires an associate’s degree in nursing.
• Minimum 6 years care management or case management experience; 2+ years clinical, utilization review, or managed care experience.
• Current active, valid RN license and/or licensure to practice in applicable state(s); multi-state licensure required if providing services in multiple states.

Aufgaben

• Identify and drive process or policy improvements.
• Coordinate team coverage and workload.
• Provide hiring and promotion input for nurses on the team.
• Serve as a resource to nurses and clinicians.
• Provide staff training and improve orientation materials.
• Complete quality audits and develop corrective action plans.
• Lead or participate in cross-functional projects and process improvements.
• Assist with reviewing complex cases and overflow work.
• Collaborate with healthcare providers to promote quality outcomes and cost-effective services.

Kenntnisse

People management

Project management

BSN

Specialty Pharmacy experience

Bilingual

Drug Manufacturer experience

Telephonic Nursing experience

Ausbildung

Associate’s degree in nursing

BSN (preferred)

Jobbeschreibung

Sign On Bonus: $5,000

Medical Management Nurse Lead - BioPlus Specialty Pharmacy

Anticipated Job Posting End Date: 10/22/2026

Schedule: 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.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

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.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $99,528 to $149,292

Locations: Colorado

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non‑discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.