Elevance Health

Manager

• Perform telephonic care management within scope of licensure for members with complex and chronic care needs
• Assess member needs and develop individualized care management plans
• Implement care plans through authorizations and referrals within benefits structures or extra-contractual arrangements
• Coordinate internal and external resources
• Monitor and evaluate care plan effectiveness and modify plans as needed
• Interface with Medical Directors and Physician Advisors on treatment plans
• Negotiate reimbursement rates when applicable
• Assist with provider, claims, and service issue resolution
• Ensure member access to appropriate health services

Nurse Case Manager I

Consultant

• Provide 24/7 Behavioral Health and Employee Assistance services to approximately 10 million lives
• Respond to initial customer contacts and requests for EAP services
• Receive client requests, assess situations, and determine appropriate courses of action
• Provide telephone and/or on-site crisis intervention, assessment, short-term problem resolution, and referrals
• Manage Critical Incident Stress Debriefing requests
• Assess members and help them access behavioral healthcare benefits under their health plans
• Manage the shared mailbox and review and place forwarded information into the documentation system

Behavioral Health Consultant I

Nurse Practitioner

• Lead quality documentation and value capture for provider visit medical encounters
• Ensure accurate ICD-10 diagnosis coding
• Serve as subject matter expert on CMS Risk Adjustment and quality documentation
• Develop and deliver clinical-focused training on advanced coding and documentation
• Incorporate coder feedback into training and documentation practices
• Liaise with clinical leadership to align goals and workflows supporting value capture initiatives
• Develop performance management plans, KPIs, and clinical-level tracking for quarterly coding goals
• Develop and manage clinical quality reviews, peer reviews, and clinical quality chart audits
• Establish chart-review targeting, audit percentages, scoring guidelines, feedback mechanisms, and remediation compliance
• Develop operational and clinical workflows to close HEDIS care opportunities
• Participate in peer review of medical documentation and patient profile information in the EMR
• Hire, train, coach, counsel, and evaluate direct reports

Manager, Clinical Performance & Quality Coding – Nurse Practitioner or PA

Product Manager

• Act as a member of the Agile leadership team
• Serve as the functional and/or client or business representative for projects within a market focus
• Act as the customer proxy and liaison between the business and Scrum Teams
• Translate features into complex user stories within the team backlog
• Manage, rank, and prioritize the backlog according to stakeholder requirements and priorities
• Perform final testing and acceptance of user stories
• Communicate stakeholder needs to the team to meet contractual requirements and acceptance criteria
• Collaborate with teams to discover and deliver solutions to market problems presented by the Product Manager
• Coordinate, rank, and prioritize business needs and plan solutions for business value
• Manage solution concept development to align the product team with direction and vision
• Create and maintain the backlog throughout the project lifecycle
• Translate the product backlog into user stories and define acceptance criteria
• Represent stakeholders as the Product Management business proxy and decision point
• Review and accept or reject results during Sprints and Sprint Reviews
• Attend Sprint meetings and provide clarifications and acceptance of user stories
• Create or contribute to project release plans
• Present work from the Team Backlog during Sprint Planning, negotiate with the team, and define Sprint goals

Senior Product Owner

• Perform case management telephonically and/or through home visits within scope of licensure
• Use screening criteria knowledge and clinical judgment to assess member needs
• Conduct assessments to identify individual needs
• Develop care plans addressing assessment objectives and goals
• Monitor and evaluate care-plan effectiveness and modify plans as needed
• Support member access to appropriate, quality, and cost-effective care
• Coordinate with internal and external resources to meet identified member needs
• Collaborate with providers

Behavioral Health Case Manager I

Collections

• Follow established guidelines and contact groups to collect past due insurance premiums and/or past due health insurance claims
• Research the validity of past due and/or disputed debt
• Generate demand letters
• Prepare reports reflecting the status of credit and collection activities for management review
• Perform complex collection activities related to past due health insurance premiums and/or past due health insurance claims

Senior Credit & Collections Specialist

Pharmacist

• Manage the selection and utilization of pharmaceuticals
• Support clinical utilization management programs including prior authorization, step therapy, and quantity limitations
• Research and synthesize detailed clinical data related to pharmaceuticals
• Prepare and present therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee
• Serve as a clinical resource to other pharmacists on prospective, inpatient, and retrospective DURs
• Provide dosage conversion and clinical support for therapeutic interventions
• Lead development and maintenance of clinical criteria for drugs processing on pharmacy and medical benefits
• Research and synthesize clinical evidence related to the efficacy and safety of drugs and biologics
• Review clinical evidence and guideline recommendations to create and maintain clinical utilization management edits
• Prepare and present drug clinical criteria through the quarterly Pharmacy and Therapeutics process
• Work with clinical operations teams to ensure claims system setup and clinical review algorithms are in place
• Present and collaborate with medical directors, pharmacists, nurses, and business area leads
• Provide drug information support to internal stakeholders
• Serve as a clinical pharmacy resource to pharmacy account management and trend management teams
• Ensure pharmacy utilization management edits comply with state and federal mandates and contractual agreements
• Monitor and evaluate the drug pipeline

Clinical Pharmacist

Vice President

• Develop and execute Carelon's external growth strategy
• Identify and acquire new business to meet revenue and profitability goals
• Organize and lead sales efforts with new and existing clients across all customer channels
• Align sales efforts with the Carelon business plan, solution roadmap, and client engagement activities
• Collaborate with Carelon's marketing group on marketing and communications
• Lead a team of 7 direct reports and approximately 12 indirect reports
• Identify, target, and secure new business from existing and new clients
• Conduct market validation research, constituent outreach, and sales prospecting
• Build market insights, sales pipeline, and positioning to support product/service selling strategies
• Synthesize validation studies, internal perspectives, analyses, and reports into sales growth playbooks
• Manage and coordinate marketing and communications with the appropriate leader
• Establish sales and supporting functions for new client and new market growth
• Support proposal responses and content development for growth initiatives
• Hire, train, coach, counsel, and evaluate direct reports
• Travel to worksites and other locations as necessary

Staff VP – Behavioral Health

• Perform care management within the scope of licensure for members with complex and chronic care needs
• Assess, develop, implement, coordinate, monitor, and evaluate care plans across the care continuum
• Perform duties telephonically or on-site, including at hospitals for discharge planning
• Ensure members understand benefits and assist with access to appropriate services
• Conduct assessments to identify individual needs and create care management plans
• Implement care plans through education and facilitation of authorizations/referrals
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate care plan effectiveness and modify plans as necessary
• Interface with Medical Directors and other health professionals on treatment plans
• Assist members and providers with access to care, vendors, claims, and service issues

Telephonic RN Nurse Case Manager I

General

• Serve as the initial and main point of field contact between the Company and current and potential members
• Provide timely and accurate resolution of inquiries and issues regarding benefits, services, and policies
• Support and promote State Sponsored Programs through participation in community events
• Represent State Sponsored Programs in community collaborations
• Support member access to care through home visits, report processing, and distribution of collateral materials
• Perform new member orientations
• Take ownership of issues to ensure timely resolution or follow-up
• Provide professional and courteous customer service
• Address the cultural and linguistic needs of the Medicaid and SCHIP population
• Work with community-based organizations, providers, plan members, and company associates
• Handle calls, texts, facsimiles, and electronic queues while taking notes and speaking with customers
• Perform other duties as assigned

Outreach Specialist

General Counsel

• Serve as a key member of the Digital & Corporate Enterprise Legal team
• Provide legal advice on AI, SaaS, software as a medical device, technology product development lifecycle, and data use
• Advise business stakeholders and coordinate with lines of business attorneys
• Negotiate Master Service Agreements, Statements of Work, SaaS Agreements, MOUs, and Partner Agreements
• Advise clients on legal risks and propose risk mitigation options
• Implement risk mitigation options with cross-functional stakeholder teams
• Develop and maintain contract templates and negotiation playbook
• Review and advise sales teams on client RFP responses for technology-related services and products
• Analyze changing regulations and provide legal advice on gap assessments and mitigating controls
• Research and support strategic positions regarding technology use
• Provide ongoing internal education and training on legal issues
• Prioritize competing priorities and produce high-quality work in a fast-paced environment

Legal Counsel – Technology

Research Scientist

• Define and drive enterprise artificial intelligence and machine learning strategy aligned with organizational priorities
• Lead the design, validation, deployment, monitoring, and continuous improvement of advanced artificial intelligence and machine learning solutions
• Architect scalable end-to-end production systems, including model training, evaluation, deployment, monitoring, and lifecycle management
• Translate complex business challenges into scalable artificial intelligence solutions with measurable outcomes
• Establish technical standards, reusable patterns, and best practices for enterprise artificial intelligence development and governance
• Partner with business and technology leaders to influence capability roadmaps and deliver sustainable business value
• Mentor data scientists, machine learning engineers, researchers, and technical leaders
• Lead the design, development, deployment, and scaling of advanced artificial intelligence and machine learning solutions that drive enterprise transformation and measurable business outcomes
• Serve as a senior technical authority for artificial intelligence strategy, architecture, governance, and production implementation

Principal Applied Scientist

Compliance

• Lead TPRM and GRC transformation initiatives from strategy and requirements through implementation, adoption, and continuous improvement
• Partner with Risk, Compliance, Security, Procurement, Vendor Management, Legal, Operations, and Technology teams to define future-state capabilities and sustainable solutions
• Translate business, risk, and policy needs into process designs, workflows, platform requirements, user stories, acceptance criteria, and priorities
• Improve the third-party risk lifecycle, including assessments, due diligence, scoring, controls, remediation, monitoring, reporting, and data quality
• Guide platform design, configuration, testing, deployment, roadmap planning, backlog prioritization, governance, and release readiness
• Build stakeholder alignment and drive communications, training, adoption, and measurable business outcomes
• Identify potential issues, project changes, and scope
• Identify impacted parties, business partners, and required resources
• Design methods for integrating functions and processes
• Conduct cost/benefit analyses
• Build support for business change throughout the business unit
• Work with management to identify and implement projects, programs, and plans supporting business unit and enterprise goals

Business Change Manager – Third Party Risk, GRC

• Conduct assessments to identify individual needs and develop care management plans
• Implement care plans by facilitating authorizations and referrals
• Coordinate internal and external resources
• Monitor and evaluate care plan effectiveness and modify plans as necessary
• Interface with Medical Directors and Physician Advisors on treatment plans
• Negotiate reimbursement rates as applicable
• Help resolve provider, claims, and service issues
• Develop utilization and care management policies and procedures
• Chair and schedule meetings and present cases at Grand Rounds/Care Conferences
• Participate in interdepartmental and cross-brand workgroups
• Develop focused expertise in disease processes or traumatic injuries
• Serve as preceptor for new care management staff
• Participate in audits and assist with day-to-day workflow management
• Deliver constructive coaching and feedback and develop corrective action plans as directed
• Serve as first-line contact for conflict resolution
• Develop training materials
• Complete quality audits and process evaluations
• Test and monitor systems and process enhancements
• Perform care management telephonically or on-site, including hospital discharge planning

Lead Nurse Case Manager

• Ensure special programs are equipped to take a “Technology First” approach to meeting members’ needs
• Develop person-centered and customized technology solutions aligned with members’ autonomy and independence goals
• Identify new and emerging technology
• Analyze the needs of members with disabilities and assist with selecting appropriate assistive technology
• Engage with internal coordination teams to evaluate opportunities for assistive technology applications
• Review members’ person-centered support plans for assistive technology integration opportunities
• Engage with members, housing specialists, and employment specialists to evaluate assistive technology applications supporting employment and community living outcomes
• Remain current on emerging technology and identify resources and applicability to members
• Collaborate with Provider Services to increase available assistive technology vendors/providers and recommend vendor recruitment and equipment needs
• Evaluate assistive technology requests for appropriateness and budget compliance
• Provide initial and refresher assistive technology training to providers as needed