Anticipated End Date: 2026-03-31 Position Title: Med Management Nurse (US) Job Description: Medical Management Nurse Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. 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. Shift: Monday - Friday 9 am - 5:30 pm (EST) with 10 am - 7 pm (EST) shift rotation twice a month. Federal Employee Program - FEP, a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, and the foundation upon which we are creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. The Medical Management Nurse is responsible for reviewing the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of a member’s clinical presentation to determine whether to approve requested service(s) as medically necessary. Works with healthcare providers to understand and assess a member’s clinical picture. Utilizes nursing judgment to determine whether treatment is medically necessary and provides consultation to the Medical Director on cases that are unclear or do not satisfy relevant clinical criteria. Acts as a resource for Clinicians. May work on special projects and helps to craft, implement, and improve organizational policies. How You Will Make an Impact: - Utilizes nursing judgment and reasoning to analyze members’ clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. - Works with healthcare providers to promote quality member outcomes, optimize member benefits, and promote effective use of resources. - Determines and assesses abnormalities by understanding complex clinical concepts/terms and assessing members’ aggregate symptoms and information. - Assesses member clinical information and recognizes when a member may not be receiving the appropriate type, level, or quality of care, e.g., if services are not in line with diagnosis. - Provide consultation to the Medical Director on particularly peculiar or complex cases as the nurse deems appropriate. - May make recommendations on alternate types, places, or levels of appropriate care by leveraging critical thinking skills and nursing judgment and experience. - Collaborates with case management nurses on discharge planning, ensuring the patient has the appropriate equipment, environment, and education needed to be safely discharged. - Collaborates with and provides nursing consultation to the Medical Director and/or Provider on select cases, such as cases the nurse deems particularly complex, concerning, or unclear. - Serves as a resource to lower-level nurses. - May participate in intradepartmental teams, cross-functional teams, projects, initiatives, and process improvement activities. - Educates members about plan benefits and physicians and may assist with case management. - Collaborates with leadership in enhancing training and orientation materials. - May complete quality audits and assist management with developing associated corrective action plans. - May assist leadership and other stakeholders on process improvement initiatives. - May assist with training lower-level clinician staff. Minimum Requirements - Requires a minimum of associate’s degree in nursing. - Requires a minimum of 4 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: - Certification in the American Association of Managed Care Nurses is preferred. - Knowledge of the medical management processes and the ability to interpret and apply member contracts, member benefits, and managed care products is strongly preferred. - Leadership skills are strongly preferred. 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.

Company Overview FOCUS provides cloud-based, core administration solutions (FOCUS Tech) and services (FOCUS Insurance Services) for P&C insurance companies and MGAs. Using decades of industry experience, FOCUS is taking the risk out of insurtech for small, mid-size, and growth-focused insurance organizations. When you join FOCUS, you immediately become one of our most valued components – and we’re committed to investing in you. That means you can look beyond the paycheck and excellent benefits to an environment that will help you grow and achieve your professional goals through development and advancement opportunities and the support of our outstanding leaders and teammates. Overview: We are seeking a highly organized and detail-oriented Business Analyst to join our team. This role will serve as a key liaison between business stakeholders and technical teams, ensuring clear communication, thorough documentation, and successful delivery of business solutions. The ideal candidate is patient, proactive, and comfortable working with non-technical users to gather and translate requirements. Key Responsibilities - Writing requirements for Data Engineering reporting projects and ad hoc requests - Administrator for ConceptOne and ImageRight applications - Document processes for ImageRight workflows - Maintain JIRA board for Data Engineering team - Facilitate meetings, ask the right questions, and drive clarity in ambiguous situations - Communicate effectively with both technical and non-technical audiences Required Qualifications - Strong organizational skills with exceptional attention to detail - Proven ability to produce high-quality, top-level documentation - Excellent communication skills, especially when working with non-technical stakeholders - Patience and professionalism in cross-functional collaboration - Background or experience in the insurance industry - Self-starter with the ability to work independently and take initiative Preferred Qualifications (Nice to Have) - Experience with ImageRight or similar document management/workflow systems - Familiarity with Power BI or basic reporting tools - Basic understanding of SQL (ability to read and interpret queries, not necessarily write them) Key Traits for Success - Proactive and resourceful - Strong problem-solving mindset - Ability to manage multiple priorities - Curious and eager to learn Education - Bachelor’s degree in Risk Management, Insurance, preferred; 5 years relevant experience acceptable in lieu of Bachelor's degree Work Experience - 1-3 years of insurance experience - Familiarity with SDLC, Agile methodology, SCRUM, JIRA, a plus. Salary Range: $65,000-$75,000 Why join the FOCUS Team? The FOCUS Difference: - Medical, Dental, Vision, Life, Pet; Flexible Spending Account - Competitive Salaries - 401K Match - Work-Life Balance: Personal Days, PTO Days, 12 Paid Holidays, Two Paid Days for Volunteer Service, Paid Parental Leave - Short and Long-Term Disability - Employee Support Programs, Including Mental Health - Tuition Reimbursement - Matching Charitable Gift Program - Lucrative Referral Program - Commuter Benefits - Flexibility: Remote and Hybrid Opportunities Available This position is not able to be performed in California, Colorado, New York or Washington. EEO Team Focus Insurance Group is an equal opportunity employer that does not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, and gender identity), national origin, age, disability, veteran status, marital status, or any other protected characteristic. Our hiring practices ensure that all qualified applicants receive fair consideration without regard to these characteristics. Disability Team Focus Insurance Group is committed to creating an inclusive and accessible workplace for all candidates, including those with disabilities. We are dedicated to ensuring equal employment opportunities and providing reasonable accommodations to qualified individuals with disabilities. If you require reasonable accommodations to participate in the application or interview process, please contact our HR department at hrinfo@peak6insurtech.com. We will work with you to provide the necessary accommodations to ensure your full participation in our hiring process. Note to applicant: It is unlawful in Massachusetts and Maryland to require or administer a lie detector test as a condition of employment or continued employment. Please know that our company does not use lie detector tests in our hiring process.

• maintaining, monitoring, and developing the Workday HCM module • assists in gathering business requirements, troubleshooting issues, and implementing changes to improve and streamline processes • supports HRIS team with release upgrades, providing training as well as ensuring data integrity throughout the system • work with HR business partners and stakeholders to identify needs • configure Workday modules to meet business requirements • execute mass data changes in core system inclusive of EIB • document procedures, workflows, and system configurations • provide support for HRIS including researching and resolving HRIS problems • manage system security, user access, and permissions to ensure data integrity and confidentiality

About Innovative Healthcare Informatics IHI is a woman-owned consulting organization dedicated to helping customers to innovate optimize and succeed. Our customers achieve their goals while our team members of seasoned experts enjoy a work culture that promotes integrity, transparency, innovation, compassion, service and excellence. IHI is seeking a Business Process Engineer/ Business Analyst to join our team. What You’ll Do - Partner with business owners, end users, and technical teams to understand how they work today and what they need tomorrow. - Gather, document, and refine business and technical requirements for government supply chain software solutions. - Turn ideas and requirements into clear user stories, workflows, and acceptance criteria. - Analyze current processes, identify gaps or bottlenecks, and recommend practical improvements or automation. - Work closely with developers, testers, and product owners throughout the Agile lifecycle (backlog, sprints, demos, UAT). - Help create and maintain easy-to-follow documentation, diagrams, and user guides. What You Bring - Bachelor’s degree in Business, Engineering, Information Systems, or a related field. - 7+ years of experience as a Business Analyst, Business Process Engineer, or similar role. - Strong, hands-on experience using Jira for user stories, requirements, and issue tracking. - Comfortable talking with both business and technical stakeholders and translating between the two. - Solid skills in process mapping, requirements gathering, and clear written documentation. - Organized, proactive, and able to juggle multiple priorities in a team environment. - Experience with government, defense, or public-sector supply chain or logistics systems. - Familiarity with Agile/Scrum practices and tools like Confluence, Visio, and Mural. - Eligibility for or ability to obtain a U.S. government security clearance. - Preferred: Lean Six Sigma, PMP, or other professional certifications. - Preferred: 10+ years experience in business analysis or and process re-engineering. - Master's degree in information technology, business or relevant field. Who You Are - Strategic thinker who is process and technically savvy. - Excellent communicator with great customer service skills. - Facilitator who builds alignment, engagement, and trust across diverse teams. - Adaptable professional who thrives in dynamic, complex environments. Why Join Us - Competitive compensation and performance incentives. - Comprehensive health and wellness benefits. - Access to ongoing learning and professional development. - Collaborative culture that values innovation, customer service, and impact. Why You’ll Love Working Here - Meaningful work: Your solutions will directly support government missions and critical supply chain operations. - Growth: Access to training, mentorship, and opportunities to expand into product, architecture, or leadership paths. - Benefits: Competitive salary, comprehensive benefits (non-contractor), and a supportive, team-first culture.