Medical Management Nurse Lead - BioPlus Specialty Pharmacy

Anticipated End Date:

Position Title:

Job Description:

Be Part of an Extraordinary Team

BioPlus Specialty Pharmacy is now part of CarelonRx (formerly IngenioRx) and a proud member of the Elevance Health family of companies. Together CarelonRx and BioPlus offer consumers and providers an unparalleled level of service thats 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 consumers treatment journey.

Title: Medical Management Nurse Lead

Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles or 1hour commute each way of one of the following locations:

• 700 Broadway Denver CO80203
• 3634 S Maryland Parkway Las Vegas NV 89169
• 376 Northlake Blvd. Altamonte Springs FL 32701

Schedule: Fulltime MonFri 11am8pm EST.

May need to work on weekends. Will work holidays based on business need.

Build the Possibilities. Make an Extraordinary Impact.

In addition to the responsibilities of the Medical Management Nurse role the Medical Management Nurse Lead role is responsible for serving as the team lead coach and technical resource for a team of either Medical Management Nurses or Medical Management Clinicians. Contributes on hiring promotion and other jobprogression 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:

Primary duties may include but are not limited to:

• Identifies the need for and driving the 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 lowerlevel 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 crossfunctional 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 highquality costeffective services.

Minimum Requirements:

• Requires a minimum of associates 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.
• Multistate licensure is required if this individual is providing services in multiple states.

Preferred Skills Capabilities and Experiences:

• BSN highly preferred.
• Experience managing a team of 10 or more people highly preferred.
• Experience presenting data to stakeholders highly preferred.
• Bilingual or multilanguage skills preferred.
• Experience using Gensys Enterprise Rx and/or Microsoft Office Suite preferred.
• Experience creating desktop processes preferred.
• Experience working with adherence with contracts nurse audits and nurse production preferred.
• Compact nursing license preferred.

For candidates working in person or remotely in the below location(s) the salary* range for this specific position is $83840.00 $138366.00.

Locations:Colorado and Nevada

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 nondiscriminatory 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 considered to be 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 Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

Job Level:

Workshift:

Job Family:

Please be advised that 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.

Who We Are

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.

How We Work

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 marketcompetitive 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. Candidates must reside within 50 miles or 1hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/memberfacing roles to become vaccinated against COVID19 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 may contact for assistance. 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.