Elevance Health

Account Executive

• Provides strategic planning and account management for large accounts.
• Directs and manages the administration of contractual requirements and obligations.
• Manages new and renewal implementation processes for accounts.
• Interfaces with operations to ensure smooth delivery of services.
• Maintains ongoing account relationships at multiple levels throughout customer organizations.
• Makes recommendations for improvements to meet customer expectations.
• Develops implementation processes and manages reporting processes to ensure client retention and high account satisfaction.
• Provides on-site and off-site account management, including interpreting plan design, researching and resolving phone and written inquiries, and resolving claims, benefit, and enrollment issues.
• Presents monthly, ad hoc, mid-year, and annual utilization and benefit reporting to brokers and clients.
• Coordinates open enrollment meetings, renewal processes, and training sessions.
• Supports standardization across accounts and works with multidisciplinary teams to design and implement product and operational enhancements.
• Provides guidance or expertise to less experienced account service managers.
• Makes routine account visits.

Pharmacy Account Executive

Nurse

• Participate in delivery of patient education and disease management interventions
• Perform health coaching for members across multiple lines and chronic disease health improvement/management programs
• Conduct behavioral or clinical assessments to identify individual member knowledge, skills, and behavioral needs
• Identify and/or coordinate health coaching plan needs addressing assessment objectives and goals
• Interface with providers and other health professionals to coordinate member health coaching plans
• Implement and/or coordinate coaching and care plans
• Educate members regarding clinical needs
• Facilitate referrals to health professionals for behavioral health needs
• Use motivational interviewing to facilitate health behavior change
• Monitor and evaluate intervention and health coaching plan effectiveness and modify as needed
• Direct members to facilities, community agencies, and appropriate providers/networks
• Refer members to catastrophic case management

Nurse, Disease Management I

Manager

• Perform care management within scope of licensure for members with complex and chronic care needs
• Assess members and develop, implement, coordinate, monitor, and evaluate care plans
• Ensure member access to services appropriate to health needs
• Facilitate authorizations and referrals within the benefits structure or through extra-contractual arrangements
• Coordinate internal and external resources to meet identified needs
• Monitor care plan effectiveness and modify plans as necessary
• Interface with Medical Directors and Physician Advisors on care management treatment plans
• Negotiate reimbursement rates as applicable
• Assist with provider, claims, or service issues
• Perform duties telephonically or on-site, including at hospitals for discharge planning

Nurse Case Manager I

Actuary

• Complete diverse and complicated projects
• Perform complex actuarial studies
• Analyze and implement risk contracts, including experience analyses, pricing, filing, and settlement work
• Prepare management reports supporting new capitation initiatives
• Assist in training actuarial trainees, analysts, and specialists
• Coordinate and direct special actuarial projects
• Perform pharmacy claim forecasting and analysis, primarily for Medicare
• Collaborate on Pharmacy Benefits Management (PBM) initiatives
• Use Excel and SAS and expand skills in R, Snowflake, and AI tools
• Work in the office 1–2 days per week while using virtual work flexibility

Actuarial Analyst III

Pharmacist

• Administer prior authorization requests for patients whose health plans require drug prior authorizations
• Review the accuracy and completeness of prior authorization information
• Ensure supporting documents are present and meet company standards
• Assist with medical necessity documentation to expedite approvals
• Perform appropriate follow-up
• Collaborate with other departments to obtain prior authorizations and appeals
• Document insurance company interactions and prior authorization information in the system
• Review insurance denials and submit appeals as permitted by payors
• Contact physician offices to obtain demographic information or medical data

Authorization Representative II – BioPlus Specialty Pharmacy

Security Engineer

• Maintain enterprise information security policies, technical standards, guidelines, procedures, and infrastructure supporting information security compliance
• Deliver strategic protection of data at rest
• Ensure security solutions involving technology are well-conceived, designed, and implemented according to enterprise standards
• Support and troubleshoot the Protegrity platform across architecture, deployment, policy administration, integrations, performance, and operations
• Deploy and support Terraform Infrastructure as Code
• Maintain infrastructure, configuration, and code in GitHub or similar platforms
• Support secure integrations across AWS and Azure or GCP
• Implement serverless integration patterns with cloud functions
• Support Kubernetes connectivity, identity, secrets management, logging, and operations
• Use Splunk for searches, log analysis, monitoring, troubleshooting, and incident investigations
• Manage incidents, requests, changes, workflows, and catalog items in ServiceNow
• Support data protection for object storage, databases, and file-based transfers
• Support Snowflake connectivity, access controls, security models, and data integration
• Integrate applications and pipelines with HashiCorp Vault
• Perform HSM initialization, partition and user administration, key management, and integration troubleshooting
• Collaborate with team members and mentor others

Information Security Advisor – Data Protection

Sales

• Direct sales and retention strategy for large, complex national accounts
• Develop strategies and execute sales plans to achieve membership growth and financial goals
• Build relationships with internal stakeholders and potential clients to drive medical, wellness, and specialty product sales
• Lead finalist presentations and executive customer engagements for new business and strategic account opportunities
• Build relationships with broker and consultant partners in Texas and key markets
• Travel to client sites and other business locations throughout Texas and, as needed, surrounding states
• Support sales opportunities, including Second Blue opportunities where the company is selected to compete or present
• Operate primarily in the field with occasional office attendance for meetings or training
• Manage and support national medical sales opportunities for TX-based subscribers and surrounding markets

Sales RVP – National Medical Sales

Nurse Practitioner

• Collaborate with company physicians, patients’ other physicians and providers, and family members to develop complex plans of care
• Provide clinical and non-clinical support to patients
• Provide primary and urgent health care via telephone and tele-video modalities
• Serve patients receiving home and community-based services through state Medicaid programs, dual eligible members, and other assigned members
• Develop and implement clinical plans of care for adults with chronic and complex conditions
• Gather patient histories, perform physical exams, and obtain diagnostics as needed
• Develop and implement treatment plans based on patient goals and current conditions
• Identify and close gaps in care
• Address patients’ and families’ physical and psychosocial needs with interdisciplinary team support
• Educate patients and families about medication usage, side effects, illness progression, diet and nutrition, medical adherence, and crisis anticipation and prevention
• Coordinate care and resources with clinical team members, physicians, medical providers, patients, and families
• Maintain patient medical records and documentation in accordance with regulations and company policy
• Prescribe medication as permitted by state prescribing authority
• Work Monday–Friday, 8:00 am–5:00 pm EST, with rotating on-call coverage 2–3 days per month from 5:00 pm–8:00 am EST