Clinical Nurse Concierge - BioPlus Specialty Pharmacy

Anticipated End Date: 2026-05-01 Position Title: Clinical Nurse Concierge - BioPlus Specialty Pharmacy Job Description: Clinical Nurse Concierge - BioPlus Specialty Pharmacy Location: 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 Clinical Nurse Concierge is responsible for coordinating the care needs of assigned patients and develops comprehensive plans to manage care delivery across the patient care continuum. How you will make an impact: Introduce and inform current and new immunoglobulin patients and referral sources about the services and programs offered. Provide additional touchpoint to customers, be a resource for outside salespeople, and help solve problems as needed. Oversee the referral process and maintenance of EMR. Ability to thoroughly understand and explain organizations Infusion product offerings and key benefits to current and potential patients and physician customers. Act as the single point of contact for patients and referral sources ensuring high levels of customer satisfaction. Provide industry leading customer service and advocacy for BioPlus patients and customers. Intervene immediately when a potential bottleneck in our system may occur. Develop and distribute consumer/patient educational materials and resources. Communicate the story and explain competitive advantage. Discuss insurance limits and parameters of policy with patients prior to beginning services. Act as a liaison between home health agencies, home infusion center and physicians to coordinate discharge, plan for patient care and establish Plans of Treatment. Coordinate therapeutic monitoring pertinent to therapy with home health care agency, laboratory and specialty infusion center pharmacy. Coordinate pharmacy dispensing schedule with delivery of drugs and supplies. Verify disposable supplies are packed and are appropriate for patient needs. Coordinate with home health care agency, laboratory and specialty pharmacy for injectable self-administration teaching, lab coordination and shipment arrangements. Coordinate patient care at refill establishing current response to therapy and ADR/Adherence occurrences, forwarding all clinical calls to appropriate clinician, under the supervision of the pharmacist. Responsible for all activities and duties including but not limited to appropriate communications via progress notes, arranging nursing, patient communications, health care professional communications, completing scheduling board, as well as scheduling shipments via patient contact and communication in computer system, e-mail system and verbally. Coordination involvement and auditing of requirements of specific clinical programs as per policy and procedures. (REMS, IgG, Hemophilia, etc.) Participate in center QA&I to ensure achievement of excellence. Ensure compliance with all Policies and Procedures and Pharmacy and Nursing laws and regulations. Minimum Requirements: Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities and Experiences: Prior IV therapy/infusion experience (infusion center, specialty pharmacy, or outpatient/hospital setting) preferred Case Management certification (e.g., CCM or equivalent) preferred Experience managing infusion medication prior authorizations, denials, and appeals end-to-end Ability to complete deep clinical chart reviews and identify the strongest clinical rationale for coverage Skilled in writing Letters of Medical Necessity tailored to payer criteria and patient-specific facts Proven success preparing and submitting 1st/2nd level appeals (standard and expedited) Experience supporting peer-to-peer reviews with concise clinical summaries and provider talking points Strong working knowledge of payer policies/medical necessity criteria for infusion therapies (step therapy, site-of-care, documentation requirements) Ability to use clinical guidelines and evidence to support approvals and overturn denials Detail-oriented in compiling complete, accurate documentation (records, labs, imaging, prior treatment history) Strong collaboration skills with providers, nurses, pharmacy, and revenue cycle/PA teams to prevent treatment delays Track record of improving outcomes (e.g., higher approval/overturn rates, faster turnaround times, fewer repeat denials) Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse 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 market-competitive 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. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 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 elevancehealthjobssupport@elevancehealth.com 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. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13. Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading. Join our Talent Community and stay connected with company news, information, and future job opportunities. Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.  Our nearly 100,000 associates serve approximately 100M people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.  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 ehjobssupport@elevancehealth.com 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. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration Please visit the Contract Worker Community Page. Elevance Health is an Equal Opportunity Employer/Disability/Veterans.