Nursing Manager - BioPlus Specialty Pharmacy at Elevance Health in Altamonte Springs, Florida

Job Description:

Responsible to manage a team of Clinical Nurse Coordinators charged with promoting quality patient outcomes, to optimize patient health, and to promote effective use of medication. Primary duties may include, but are not limited to: Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective. Manages areas which may include facilitating authorizations for drug therapy and appropriateness of treatment setting by utilizing the applicable medical policy (formulary) and industry standards, accurately interpreting benefits and managed care products, and directing patients to appropriate providers, programs or community resources. Applies clinical knowledge to work with facilities and providers for care-coordination. Serves as mentor to lower leveled managers and as subject matter expert for other areas of the company and within the department. Manages multiple functions requiring unique sets of knowledge or has significant fiscal accountability. Develops and manages annual operating budget. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Requires a HS diploma or equivalent and a minimum of 5 years acute care clinical experience which includes a minimum of 2 years prior management experience; or any combination of education and experience, which would provide an equivalent background. Current, active, valid unrestricted RN license to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required, except in government business where it is preferred. BS preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Required to follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which the associate is employed.