Medical Management Nurse Lead - BioPlus Specialty Pharmacy

Medical Management Nurse Lead - BioPlus Specialty Pharmacy

Sign On Bonus: $5,000

Schedule: Varied Shifts. May need to provide weekend/holiday support.

Work Location: 3200 Lake Emma Rd. Ste 1000, Lake Mary, FL 32746

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.

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.