Elevance Health

Product Manager

• Represent the needs and desires of the stakeholder community to Agile teams.
• Serve as the expert on the market and customer.
• Drive the solution concept across multiple Agile teams.
• Lead product strategy, definition, positioning, roadmap development, portfolio management, competitive analysis, win/loss analysis, forecasting, and ecosystem value delivery.
• Communicate customer needs and participate in validation of proposed solutions.
• Collaborate with Product Owners to develop and communicate the vision for Scrum teams.
• Manage the Program Epic/Initiative backlog at the Agile Lean Program level.
• Partner with stakeholders to develop business cases for Epics and features affecting the Agile Release Train or team of Agile teams.
• Make product and program decisions based on customer needs.
• Use KPIs to measure product performance.
• Support portfolio work, including budget parameters and strategic themes.
• Advocate for funding, drive funding requests, and secure budgets for continuous customer value delivery.
• Collaborate with system and solution architects on technical decision-making and sequencing.
• Build an effective Product Manager/Product Owner team across multiple trains.
• Mentor Product Managers in driving solutions across teams.
• Drive business value delivery at the program level.

Agile Product Manager

Learning and Development

• Analyze, design, build, and implement business-aligned, integrated learning solutions
• Collaborate with business partners on expected business outcomes
• Participate in needs analysis and recommend effective learning solutions
• Collaborate with content developers, graphic designers, technology consultants, technologists, and other project team members on learning solution design, development, implementation, and evaluation
• Use approved processes, tools, and templates for development and reporting
• Actively maintain all content
• Participate in the quality review process
• Contribute to Learning & Development sub-teams, communities of practice, and knowledge- and skill-enhancement opportunities

Learning Experience Designer II

Director

• Develop the provider network through contract negotiations, relationship development, and servicing for large health systems and affiliated physician groups
• Focus on contracting and negotiating contract terms for complex health systems and affiliated providers
• Drive and support value-based initiatives
• Lead associate resources, special projects, initiatives, or network planning
• Serve as a subject matter expert for local contracting efforts or specialized contracting components
• Lead large-scale, multi-faceted negotiations
• Represent the business unit on enterprise network-management initiatives
• Lead projects with significant business-unit impact
• Assist management in network development planning
• Provide work direction and establish priorities for field staff
• Support associate development and mentoring
• Negotiate non-standard arrangements and customized fee schedules
• Work independently using judgment and discretion
• Collaborate with key areas on business-unit and enterprise network-management projects
• Collaborate with sales teams on presentations to employer groups
• Serve as a communication link between providers and the company
• Conduct complex negotiations
• Prepare financial projections and conduct analysis

Provider Network Management Director

Manager

• Provide telephonic care management for members with complex and chronic care needs
• Assess members and develop specific care management plans
• Implement care plans through authorizations and referrals within benefits structures or extra-contractual arrangements
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate care management plans and modify them as necessary
• Interface with Medical Directors and Physician Advisors on treatment plans
• Negotiate reimbursement rates as applicable
• Assist with provider, claims, or service issue problem-solving
• Assist with development of utilization and care management policies and procedures
• Ensure member access to services appropriate to health needs

Telephonic Nurse Case Manager II

• 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
• Ensure member access to services appropriate to their health needs
• Conduct assessments to identify individual needs and care management objectives
• Facilitate authorizations and referrals within the benefits structure or through extra-contractual arrangements
• 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 Physician Advisors on care management treatment plans
• Negotiate reimbursement rates, as applicable
• Assist with provider, claims, or service issue resolution
• Perform duties telephonically or on-site, including hospital discharge planning
• Visit members in person within Orlando, Florida

Pediatric Nurse Case Manager I

• Direct strategic direction and tactical leadership within Workforce Management across Elevance Health Contact Centers
• Develop and execute organizational forecasts and capacity plans in high-volatility contact center environments
• Forecast and schedule capacity across voice, chat, email, messaging, and asynchronous work
• Apply skills-based routing and channel-blending strategies to optimize occupancy and service level
• Model the impact of self-service, digital containment, and AI-assisted resolution on contact volume, mix, and handle time
• Forecast blended human and digital capacity requirements
• Partner with stakeholders to establish workforce budgets and meet customer needs and contractual commitments
• Ensure staffing and capacity plans support performance guarantees, service level agreements, and regulatory service standards
• Identify performance risks and drive mitigation strategies
• Align outsourced capacity, adherence, and performance with enterprise forecasts and service commitments
• Design flexible scheduling strategies, including hybrid and remote staffing models, shift bidding, agent self-service, and on-demand coverage pools
• Lead scenario and what-if modeling for peak periods, disruptions, and business continuity events
• Ensure workforce data governance, integrity, and consistency
• Conduct operational review meetings and analyze forecast and performance variance
• Provide analysis, presentations, and strategic recommendations for business improvements
• Sponsor integrated workforce support and standardize processes for scale and efficiency
• Lead AI and automation adoption, reskilling associates for AI-augmented roles, and fostering responsible AI use
• Leverage and evaluate AI and machine learning technologies for forecasting, scheduling, intraday management, and decision-making
• Create criteria for workforce management evaluation systems and assess workforce management activities
• Ensure technology solutions are used consistently
• Hire, train, coach, counsel, and evaluate direct reports
• Travel to worksites and other locations as necessary

Director, Workforce Management – Service Experience

• Perform telephonic care management for members with complex and chronic care needs
• Assess members and develop individualized care management plans
• Implement care plans by facilitating authorizations and 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 Physician Advisors on treatment plans
• Negotiate reimbursement rates as applicable
• Assist with provider, claims, or service issues
• Ensure member access to appropriate health services
• Service members across different states

Nurse Case Manager I

Security Engineer

• Lead threat intelligence, detection engineering, threat hunting, and phishing resiliency functions
• Translate the external threat landscape and internal telemetry into measurable risk reduction
• Build, mentor, and retain a multidisciplinary cybersecurity team
• Advise executives on the threat landscape, detection posture, and risk-based prioritization
• Partner with privacy, legal, law enforcement, intelligence community, and intelligence-sharing organizations
• Direct the enterprise Cyber Threat Intelligence program, strategy, requirements, and operating model
• Oversee analysis and reporting on adversary tactics, techniques, procedures, threat actors, and emerging threats
• Set the strategy and operating model for threat intelligence, threat hunting, and AI-enabled detection engineering
• Drive zero-trust cyber defense through visualization, correlation, and analytics
• Manage vendors and external intelligence-sharing partnerships
• Own the detection engineering lifecycle from hypothesis through deployment, tuning, and deprecation
• Map detections to MITRE ATT&CK and real-world threat feeds
• Drive purple-team and red-team exercises with attack-surface management and red teams
• Integrate automation and AI capabilities with the AI SOC
• Establish team OKRs aligned to business risk, security priorities, and industry frameworks
• Govern adoption of agentic security solutions with safety, auditability, human-in-the-loop controls, and measurable value
• Communicate complex threats and trends to executives and business stakeholders through verbal briefings and written threat intelligence reports

Director I – Cybersecurity, Threat Intelligence & Engineering

Auditor

• Identify issues and/or entities that may pose potential risk associated with fraud and abuse
• Examine claims for compliance with relevant billing and processing guidelines
• Identify opportunities for fraud and abuse prevention and control
• Review and analyze claims and medical records prior to payment
• Use required systems/tools to accurately document determinations and continue to the next step in the claims lifecycle
• Research new healthcare-related questions to aid investigations
• Stay current on medical coding and billing issues, trends, and changes in laws/regulations
• Collaborate with the Special Investigation Unit and other internal areas on matters of mutual concern
• Recommend interventions for loss control and risk avoidance based on investigation outcomes
• Assist with training new associates

Clinical Provider Auditor II

• Manage the lifecycle of payor contracts, including review, interpretation, implementation, amendments, and renewals
• Serve as subject matter expert on contract terms, reimbursement methodologies, fee schedules, carve-outs, drug-level pricing, site-of-care requirements, and network participation
• Track contract expirations, renewals, and amendments
• Analyze reimbursement methodologies and identify reimbursement risks, underpayments, and revenue leakage
• Partner with finance and revenue cycle to resolve reimbursement discrepancies and payment disputes
• Support forecasting, margin analysis, and payor profitability reporting
• Translate contract terms into operational requirements for pharmacy systems, billing platforms, and claim adjudication logic
• Coordinate with IT and pharmacy operations to ensure accurate pricing and payor-specific rule setup
• Support payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations
• Ensure contracts comply with federal and state regulations and maintain audit-ready documentation
• Support internal and external audits
• Act as primary contract resource for internal teams and provide contract education
• Support payor escalations, access issues, and network participation inquiries

Payor Contract Manager – Infusion

Enrollment Specialist

• Review and prioritize patient census
• Reach out to patients to explain services and enroll them into appropriate programs based on the line of business
• Coordinate with clinical and care coordination teams to ensure seamless patient onboarding
• Meet or exceed enrollment targets and key performance indicators
• Address inquiries and schedule initial and annual appointments
• Enter documentation into designated systems

Patient Enrollment Specialist I – Virtual

Research Scientist

Anticipated End Date:
2026-09-24
Position Title:
Researcher Senior (Health Services)
Job Description:
Researcher Senior (Health Services)

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.

The Researcher Senior (Health Services) is responsible for prospective and retrospective health services, economic and epidemiologic research activities for Elevance Health, Carelon and external clients. The focus area includes implementation sciences, population health, evidence-based care (drug, procedures, vaccine& and medical device) and policy research.

How you will make an impact:

- Lead or support scientific aspects of research activities in the following areas: proposal development, research designs, methodologies, analytical techniques, data analyses, and reporting.

- Use subject matter expertise in leading or supporting the development of protocols, statistical analysis plans, analyses, reports, and publications.

- Lead or support the development of detailed specifications for study databases and analysis files, consistency checks, tables, and figures and communicates requirements to the programming group.

- Conduct analyses of administrative claims/electronic medical records/survey data and review of statistical output to ensure the superior quality of research activities and client deliverables.

- Responsible for the final quality and accuracy of study deliverables, presentation of study deliverables and facilitation of the collaboration among project team members towards development.

- Manage relationships with study champions, communicates scientific decisions, and presents key study insights to the champions, including Elevance Health senior leadership team, internal decision makers, and other external stakeholders/clients.

Minimum Requirements:
Requires a MS, MPH or PharmD in epidemiology or health sciences or related field; minimum 3 years of experience in health service research, epidemiology, biostatistics, or a related field; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

- Ph.D. is strongly preferred.

- Postgraduate or post-doctoral training or relevant experience in conducting observational and/or prospective research studies strongly preferred.

- Understanding of the U.S. health care system, population health, and social determinants of health/health related social needs strongly preferred.

- Proficient in statistical software, including SAS, STATA, R, and/or Python strongly preferred.

- Proficient in data management tools, including SQL strongly preferred.

- Experience with large healthcare datasets, such as claims data, the Medical Expenditure Panel Survey (MEPS), or the Health and Retirement Study (HRS) is strongly preferred  

- Experience in implementation sciences is strongly preferred

- Proficient in survey questionnaire development. conducting qualitative interview, or mixed method analyses is strongly preferred

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $100,584 to $150,876.
 
Location(s): Illinois; Massachusetts
 
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
 
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level:
Non-Management Exempt
Workshift:
1st Shift (United States of America)
Job Family:
RDA > Research Data
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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. 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.

Researcher Senior (Health Services)

General

• Gather clinical information regarding cases and determine the appropriate area to refer or assign each case
• Provide information regarding network providers or general program information when requested
• Assist with complex cases
• Act as liaison between Medical Management and/or Operations and internal departments
• Maintain and update tracking databases
• Prepare reports and document all actions
• Provide non-clinical support to Medical Management and/or Operations
• Exclude utilization management review activities requiring interpretation of clinical information

Medical Management Specialist I

Consultant

• Employ advanced analytics to gain insights into member behavior drivers and preferences, product/program concepts and value propositions, operational effectiveness and efficiencies, and client-specific health gaps and needs
• Consult business leaders and internal partners to apply insights to test and drive product innovation and enhancement
• Measure program outcomes and demonstrate value
• Help win and retain clients and support information-based strategic decision-making
• Provide analytical insights for business solution development based on quality, use, cost and other key drivers
• Develop and refine analysis templates for problem diagnosis and opportunity assessment
• Consult on designing and executing tests or pilot programs
• Contribute to new program or initiative design based on test/pilot outcomes
• Develop targeting criteria and customer segmentation based on analytical, clinical, product and operations inputs
• Develop predictive models and other tools to target the right members
• Develop methodologies to measure clinical, utilization and financial outcomes
• Conduct in-depth research on challenging outcome-measurement issues
• Lead applied research projects
• Author white papers, present at industry conferences and submit journal publications
• Address limitations of data sources and evaluate the incremental value of new data sources

Advanced Analytics Consultant

• Deliver strategic network security, access control, and secure transaction/messaging solutions
• Ensure technology-based security solutions are well-conceived, designed, and implemented in compliance with enterprise standards
• Maintain enterprise information security policies, technical standards, guidelines, procedures, and infrastructure elements
• Provide first-level engineering design and trouble resolution, including technical escalation for complex problems
• Lead or plan implementations for access management and network security technologies
• Develop testing plans to ensure implementation quality
• Lead investigation and reporting of data security events and incidents
• Provide system and network architecture support for information and network security technologies
• Support business and technology associates in risk assessments and implementation of information security procedures, standards, and technologies
• Maintain security incident response plans
• Represent major upgrades and business system replacements in change control
• Oversee enterprise mix of vendor services and help set vendor strategy
• Recommend changes and updates to security strategy
• Design and engineer repeatable technical solutions based on business requirements and technology standards
• Develop support procedures and performance metric reports
• Lead Level 1 and Level 2 incident recoveries and root-cause analysis
• Organize analyst efforts during incident recovery when needed
• Design, develop, tune, and maintain security detections, correlation rules, and behavioral analytics
• Develop and maintain CI/CD pipelines for deployment, testing, and validation of detection content
• Collaborate with CSOC, Fraud, Threat Intelligence, Infrastructure, and Engineering teams to enhance monitoring capabilities