Elevance Health

Sales Development Rep

• Identify, engage, and cultivate relationships with potential clients and current customers
• Deploy efficient lead-generation processes and metrics
• Create and nurture high-quality leads
• Contact prospects via email, phone, and social media to initiate contact and schedule discovery meetings
• Conduct market research to identify growth opportunities and target segments
• Analyze lead-generation efforts and communicate results
• Produce regular performance reports, insights, and recommendations for senior management
• Collaborate with cross-functional internal partners on business objectives, new solutions, product launches, and unique selling propositions
• Use lead-generation products, platforms, and core technology stack
• Establish and optimize end-to-end lead-generation processes for high conversion rates
• Ensure lead-generation activities comply with regulations and best practices
• Drive outbound activity, connections, response time, meetings set and held, pipeline generated/influenced, conversion rates, data hygiene, and process adherence

Lead Generation Specialist / Sales Development Representative

Engineer

• Lead the design, development, and modernization of enterprise workflow experiences
• Partner with product, design, business units, platform teams, and enterprise architecture to simplify processes and improve user experience
• Architect and deliver scalable, resilient AI solutions using agentic systems, LLMs, distributed systems, and event-driven architectures
• Define enterprise-wide technical direction, architecture patterns, integration standards, and reusable platform capabilities
• Lead AI-driven modernization of legacy systems through automated code transformation, service decomposition, and continuous optimization
• Design and implement AI-enabled software development lifecycle practices
• Establish technical standards, governance frameworks, monitoring, evaluation, and responsible AI best practices
• Collaborate with UX, product management, engineering, operations, architecture, security, compliance, and business stakeholders
• Enable adoption of AI-assisted development and drive continuous improvement in system performance and productivity
• Modernize legacy workflow tools, forms, portals, manual processes, and fragmented user experiences
• Provide technical leadership and mentorship and influence enterprise technology decisions and AI investments

Distinguished Engineer

Business Analyst

• Act as a liaison between IT and business partners
• Drive the end-to-end user acceptance testing process
• Translate complex business requirements into UAT test plans, test cases, and cross-functional acceptance criteria
• Execute SQL queries for data extraction and validation
• Assess process improvement opportunities through business process modeling
• Collaborate with programming and testing teams across all testing phases
• Co-manage the UAT cycle with the IT QA Lead
• Facilitate test execution
• Lead defect triage and document severity, priority, and root causes
• Develop and present educational materials to train business partners
• Obtain detailed test scenarios and secure formal testing signoffs
• Provide daily execution metrics and status updates to project leadership
• Analyze complex end-user needs to determine optimal UAT test plans
• Determine business application software requirements
• Develop project plans and coordinate resources
• Support software users with questions and issues
• Provide direction and guidance to team members as an expert resource

Business Analyst III

Medical Director

• Support behavioral health utilization management activities for Florida Medicaid
• Conduct peer-to-peer discussions with providers
• Perform chart reviews as needed
• Support utilization management and care management teams with clinical expertise
• Participate in clinical rounds and provide psychiatric consultation
• Deliver clinical feedback to external providers and internal staff
• Support clinicians to ensure timely and consistent responses to members and providers
• Provide guidance for clinical operational aspects of a program
• Conduct peer-to-peer clinical reviews with attending physicians and other providers regarding review determinations and patient office visits
• Conduct peer-to-peer clinical appeal case reviews as needed
• Serve as a resource and consultant for other company areas
• Represent the company to external entities and serve on internal or external committees as required
• Chair company committees as needed
• Interpret medical policies and clinical guidelines
• Develop and propose new medical policies based on healthcare changes
• Lead, develop, direct, and implement clinical and non-clinical activities affecting healthcare quality, cost, and outcomes
• Identify and develop innovation opportunities to increase effectiveness and quality

Behavioral Health Medical Director – Psychiatrist

Manager

• Conduct service coordination functions for a defined caseload of individuals in specialized programs
• Facilitate Person Centered Planning with supported individuals
• Conduct assessments and develop comprehensive Person Centered Support Plans and backup plans
• Interface with Medical Directors and participate in interdisciplinary care rounds
• Engage members’ support circles and manage physical health, behavioral health, and LTSS needs
• Perform face-to-face program assessments using predefined tools and questions
• Apply motivational interviewing techniques for evaluations, coordination, and waiver or behavioral/physical health needs management
• Identify members with potential clinical healthcare needs and coordinate cases with clinical healthcare management and interdisciplinary teams
• Manage non-clinical needs of members with chronic illnesses, comorbidities, and disabilities
• Document short- and long-term service and support goals with members’ chosen care teams
• Identify members who may benefit from alternative service levels or waiver programs
• Mentor, train, and support new staff as a subject matter expert or preceptor
• Submit utilization and authorization requests with supporting care-plan documentation
• Report critical incidents to internal and external parties, including state and county agencies
• Assist with appeals, fair hearings, member grievances, appeals, and state audits

LTSS Service Coordinator – Case Manager, Region C: Pasco/Pinellas

Product Manager

• Develop products in both new and existing markets
• Evaluate existing products and competitor and industry data to improve products and recommend new products
• Develop and implement long-term profitability strategies for market segments, including market positioning, new product design pricing parameters, risk profiles, and legislative/regulatory responses
• Coordinate presentation, communication, and implementation of all phases of product development
• Ensure products comply with regulatory directives and state/federal laws and policies
• Serve as a product expert and relationship manager to core clients
• Partner cross-functionally to develop go-to-market materials, including FAQs, talking points, and product blurbs, enabling Sales and Account teams while meeting delivery timelines

Senior Product Manager – Carelon Rx

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

Nurse Case Manager I

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 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 and facilitate referrals to behavioral health professionals
• Use motivational interviewing to facilitate health behavior change
• Monitor and evaluate intervention and health coaching plan effectiveness, modifying plans as needed
• Direct members to facilities, community agencies, and appropriate provider/network
• Refer members to catastrophic case management

Nurse Disease Management I

General

• Develop and execute the regional sales strategy to drive adoption and utilization of BioPlus Specialty Pharmacy for specialty medications
• Focus on specialty medication areas including Oncology, Dermatology, Rheumatology, and Gastroenterology
• Maintain sales effectiveness within the assigned territory through regular in-person meetings and support for healthcare providers and staff
• Use databases, Salesforce, and other tools to identify key accounts, document sales activity, and analyze performance metrics
• Develop and foster account relationships with effective communication and customer service
• Maintain and document a call cycle
• Build and maintain relationships with providers, biologic coordinators, medical assistants, clinical teams, and pharmaceutical partners
• Support specialty pharmacy activity, including educational resources and reimbursement processes
• Partner with leadership to formulate and execute business objectives
• Communicate information about competitors, issues, and business threats
• Attend sales meetings, conferences, training programs, and conventions
• Travel within the designated region

Regional Account Liaison

Referral Specialist

• Provide support to a clinical team to facilitate the administrative components of clinical referrals
• Act as a first-level subject matter expert beyond intake calls, including production-oriented work, physician assisting, and special projects
• Serve as a liaison between hospitals, health plans, physicians, patients, vendors, and other referral sources
• Review complex referrals for completeness and follow up for additional information
• Assign referrals to staff as appropriate
• Verify insurance coverage and obtain authorizations from insurance plans when needed
• Contact physician offices to obtain demographic information or related data
• Enter referrals and document communications, actions, and other data in the system
• Handle calls, texts, facsimiles, and electronic queues while taking notes and speaking with customers
• Perform other duties as assigned

Referral Specialist II

Representative

• 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 the payor
• Contact physician offices to obtain demographic information or medical data as needed

Authorization Representative II

Attorney

• Lead support staff and provide legal support services for multiple states, enterprise-wide functions, and/or litigation
• Serve as a seasoned resource and coach other support staff
• Prepare and evaluate legal documentation to resolve problems
• Respond to regulatory inquiries and investigations
• Conduct legal research and analysis and recommend appropriate actions and next steps
• Perform fact checking and gather documents
• Research and respond to subpoenas, records requests, and inquiries from internal and external sources
• Coordinate investigation and discovery activities
• Lead the investigation and resolution of complex cases
• Monitor state and federal legislation affecting the corporation
• Implement recommendations related to regulatory and legal changes
• Apply business knowledge and technical expertise to optimize solutions and improve practices
• Participate in project management, negotiations, and strategizing with business and staff
• Enter information into databases and document management systems

Senior Legal Specialist

Clinical Operations

• Manage clinical program development for population-based clinical quality measures, including Medicare Star, within a clinical area and across all lines of business
• Provide strategic leadership for Medicare clinical and quality programs, overseeing account management, Stars and CAHPS
• Lead ideation through implementation of clinical Medicare quality and patient experience programs
• Oversee vendor contracts, negotiations and service-level agreements; continuously monitor vendor performance
• Create workflows, prioritize work and manage multiple projects while meeting deadlines
• Evaluate industry best practices, medical research and other resources to develop clinical programs and tools supporting quality, cost-effective care
• Develop and implement an annual plan detailing strategies, programs and tools
• Lead program development activities
• Develop and coordinate presentations, communications and implementation for all phases of clinical program/tool development and implementation
• Ensure programs and tools comply with regulatory directives and state/federal laws and policies
• Identify system needs to implement clinical programs
• Develop system requirements and ROI
• Track program performance and results and modify programs as needed
• Provide leadership and guidance to associates involved in program development and implementation

Medicare CAHPS & STAR Quality Clinical Program Manager

• Consult on and leverage health promotion and healthy lifestyle behaviors for employers, consultants and consumers to win new business, retain accounts and grow membership
• Collaborate with Culture, Well-being and Community Engagement teams to develop multi-year health promotion plans and engagement strategies
• Conduct customer worksite wellness assessments and provide qualitative and quantitative feedback
• Plan and facilitate on-site or virtual employee well-being events
• Serve as well-being ambassador for the region
• Design customized health promotion solutions for employer and consultant communities
• Optimize wellness dollars to promote member engagement and position wellness as a competitive differentiator with clients
• Travel to health fairs approximately three to four times per year throughout the South, Midwest, and Northeast
• Occasionally travel to the client’s NYC headquarters

Health Promotion Manager

Consultant

• Provide 24/7 Behavioral Health and Employee Assistance services to approximately 10 million lives
• Support the Employee Assistance Program service department by responding to initial customer contacts and requests for services
• Receive client requests, assess situations, and determine appropriate courses of action
• Provide telephone and/or on-site support for crisis intervention, assessment, short-term problem resolution, and referral to appropriate providers
• Manage Critical Incident Stress Debriefing requests
• Assess members and assist them in accessing behavioral healthcare benefits available under their health plans
• Manage the shared mailbox used by clients and external vendors to forward information for review and placement in the documentation system