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Medical Management Nurse Lead – BioPlus Specialty Pharmacy
Elevance Health. Serve as team lead, coach, and technical resource for Medical Management Nurses or Clinicians .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in nursing leadership, care management, and clinical oversight, with a focus on process improvement and team development. Proficient in managing complex cases and collaborating with healthcare providers to enhance patient outcomes.
Highest-signal resume keywords
RN LicenseCare Management ExperienceClinical ExperienceProject Management ExperiencePeople Management Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Care ManagementClinical Utilization ReviewManaged CareQuality AuditsProcess ImprovementTraining DevelopmentTelephonic NursingSpecialty Pharmacy ExperienceCase ManagementCorrective Action Plans
Soft Skills
CoachingTeam LeadershipCommunicationCollaborationProblem-Solving
Certifications & Qualifications
RN LicenseBilingual Capability
Industry Keywords
HealthcarePatient OutcomesDrug ManufacturerQuality ImprovementMulti-State Licensure
About the role
Key responsibilities & impact- Serve as team lead, coach, and technical resource for Medical Management Nurses or Clinicians
- Contribute to hiring, promotion, and job-progression decisions
- Lead special projects and help craft, implement, and improve organizational policies
- Serve as subject matter expert and department liaison to other business-unit areas
- Identify needs for and drive process or policy improvements
- Coordinate team members to ensure appropriate coverage
- Provide recommendations for hiring and promotions
- Support lower-level nurses and clinicians
- Train staff and improve orientation and training materials
- Complete quality audits and help develop and implement corrective action plans
- Lead or participate in cross-functional teams, initiatives, and process-improvement activities
- Assist with challenging, complex, and overflow cases
- Work with healthcare providers to promote quality member outcomes, optimize benefits, and ensure effective resource use
- Consult with team members and Medical Directors to ensure medically appropriate, high-quality, cost-effective services
Requirements
What you’ll need- Minimum associate’s degree in nursing
- Minimum 6 years of care management or case management experience
- Minimum 2 years of clinical, utilization review, or managed care experience
- Equivalent combination of education and experience may be considered
- Current active, valid, and 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 required
- Multi-state licensure required when providing services in multiple states
- People management experience
- Project management experience
- BSN preferred
- Specialty Pharmacy experience
- Bilingual capability
- Drug Manufacturer experience
- Telephonic Nursing experience
- May need to provide weekend/holiday support
- Candidates must reside within reasonable commuting distance of a posting location unless an accommodation is granted
- COVID-19 and Influenza vaccination required for certain patient/member-facing roles
Benefits
Comp & perks- $5,000 sign-on bonus
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401(k) contribution and match
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical, dental, and vision benefits
- Short- and long-term disability benefits
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Hybrid work flexibility