Elevance Health

Director

• Lead development and management of annual and multi-year technology budgets
• Maintain portfolio spend models, staffing forecasts, and financial projections
• Analyze budget variances and forecast trends, recommending corrective actions
• Develop financial scenarios and cost models for strategic investment decisions
• Monitor actual spend against approved budgets and identify financial risks and opportunities
• Manage financial evaluation of staffing requests and resource investments
• Validate business justifications and quantify financial impact of hiring and contractor requests
• Maintain workforce planning models and staffing forecasts
• Partner with leadership on capacity planning, labor optimization, and funding decisions
• Serve as financial lead for the FEP technology portfolio
• Maintain portfolio-level financial dashboards and executive reporting
• Track project funding, budget consumption, forecasts, and investment performance
• Support monthly, quarterly, and annual portfolio review processes
• Coordinate annual budget planning across multiple technology organizations
• Facilitate collection, validation, and consolidation of departmental budget submissions
• Manage cost center budgets and financial allocations
• Support AIQ, DO Budget, and operating plan development processes
• Develop and present Monthly Financial Reviews for senior leadership
• Prepare executive presentations, dashboards, and financial analysis
• Deliver data-driven recommendations to leadership teams
• Ensure compliance with financial policies, funding requirements, and governance standards
• Maintain audit-ready financial documentation and reporting processes
• Support financial governance forums and executive review boards
• Manage vendor funding line administration and budget alignment
• Monitor contractor and supplier financial commitments
• Coordinate funding adjustments and budget transfers
• Leverage AI, ServiceNow, Workday, Power BI, Excel, and financial systems for reporting, automation, and analysis
• Drive continuous improvement and automation of financial management processes
• Apply AI-enabled analytics and forecasting techniques to improve financial planning accuracy
• Partner with Technology Directors, Portfolio Management, Finance, HR, Procurement, and Executive Leadership

Portfolio Director

Account Manager

• Manage the intake, assessment, tracking, escalation, and resolution of provider participation changes
• Evaluate member and network impacts, including continuity of care, alternative provider access, member communications, and provider notices
• Coordinate network adequacy analyses and regulatory submissions required by DMHC, DHCS, and other oversight entities
• Coordinate responses to regulatory inquiries and ensure accurate, complete, timely supporting documentation
• Lead regulatory audits, examinations, accreditation reviews, readiness assessments, and evidence preparation
• Develop project plans, gap analyses, milestones, risk mitigation strategies, and leadership updates
• Interpret laws, regulations, contractual requirements, and accreditation standards and provide guidance
• Develop and maintain policies, procedures, audit tools, training materials, metrics, dashboards, and compliance reports
• Identify regulatory and operational risks, recommend process improvements, and monitor remediation
• Collaborate with clinical, quality, care management, health plan, growth, and vendor management teams
• Serve as liaison with regulators, delegated entities, providers, vendors, and senior leadership
• Develop and maintain provider relationships through on-site and virtual visits, communications, education, and issue resolution
• Research complex issues affecting provider contract negotiations and network retention
• Resolve complex provider issues and appeals with providers and internal partners
• Coordinate Joint Operation Committees for provider groups
• Assist with provider satisfaction surveys, corrective action plans, education, contract questions, and non-routine claim issues
• Coordinate communications regarding administrative and medical policy, reimbursement, and provider utilization patterns
• Identify and report provider utilization patterns affecting quality of service delivery
• Organize external Provider Town Halls and seminars and attend state association conferences
• Monitor department metrics, provider assignments, and daily activities; provide performance management, training, guidance, and workflow feedback

Senior Provider Relationship Account Manager

Security Analyst

• Provide enterprise security solutions addressing business, regulatory, and legal requirements
• Assure the confidentiality, integrity, and availability of information assets
• Execute and process mainframe security and access management requests
• Manage privileged, service, shared, emergency, and non-person user accounts
• Create, update, and maintain supporting and procedural documentation
• Support Identity and Access Management activities
• Complete implementation tasks for systems and network security technologies
• Execute testing plans
• Coordinate and prepare data security event and incident reporting
• Provide system and network architecture support
• Provide technical support to business and technology associates
• Resolve complex issues
• Perform system and network upgrade tasks
• Design and analyze vendor services and information security requirements
• Maintain relationships with key vendors
• Complete lights-on initiatives for equipment consolidation and business relocations
• Perform complex configuration changes
• Perform capacity analysis and recommend and implement capacity increases
• Respond to Level 3 and 4 change and problem requests
• Lead Level 1 and 2 incident recoveries and root cause analysis

Security Analyst III – Identity and Access Management

• Manage the intake, assessment, tracking, escalation, and resolution of provider participation changes
• Evaluate member and network impacts, including continuity of care, alternative provider access, member communications, and required provider notices
• Coordinate network adequacy analyses and regulatory submissions required by DMHC, DHCS, and other oversight entities
• Coordinate responses to regulatory inquiries and ensure accurate, complete, timely supporting documentation
• Lead regulatory audits, examinations, accreditation reviews, readiness assessments, and evidence preparation
• Develop project plans, gap analyses, milestones, risk mitigation strategies, and leadership updates for regulatory initiatives
• Interpret laws, regulations, contractual requirements, and accreditation standards and advise business partners
• Develop and maintain policies, procedures, audit tools, training materials, metrics, dashboards, and compliance monitoring reports
• Identify regulatory and operational risks, recommend process improvements, and monitor remediation
• Collaborate with clinical, quality, care management, health plan, growth, and vendor management teams
• Liaise with regulators, delegated entities, providers, vendors, and senior leadership
• Maintain provider relationships through on-site and virtual visits, communications, education, and issue resolution
• Research, analyze, and coordinate resolution of complex provider issues and appeals
• Triage issues and submit work requests with internal matrix partners
• Manage an assigned portfolio of providers within a defined cohort
• Coordinate Joint Operation Committees of provider groups
• Assist with annual provider satisfaction surveys, corrective action plans, education monitoring, contract questions, and non-routine claims issues
• Coordinate communications regarding administrative and medical policy, reimbursement, and provider utilization patterns
• Conduct proactive outreach on managed care policies, procedures, initiatives, and programs
• Participate in provider town halls, seminars, and state association conferences
• Identify and report provider utilization patterns affecting quality of service
• Research issues affecting future provider contract negotiations or network retention

Provider Relationship Account Manager

Manager

• Provide 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
• Ensure member access to services appropriate to their health needs
• Conduct assessments to identify individual needs and care management objectives and goals
• 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 management plan effectiveness and modify plans as necessary
• Interface with Medical Directors and Physician Advisors on care management treatment plans
• Negotiate rates of reimbursement, as applicable
• Assist with provider, claims, or service issue problem solving
• Assist with development of utilization/care management policies and procedures

Nurse Case Manager II

Therapist

• Provide guidance to condition management members to help make positive lifestyle changes and improve respiratory health
• Collaborate with other health professionals to improve member health
• Instruct members on inhalers, breathing techniques, BiPAPs, peak flow meters, and prevention techniques
• Coach members through positive health changes using specialized education focused on Asthma and COPD
• Complete required in-person training sessions and essential face-to-face onboarding and skill development

Respiratory Therapist

Referral Specialist

• Provide support to a clinical team to facilitate administrative components of clinical referrals
• Act as a first-level subject matter expert on intake calls, production-oriented work, physician assisting, and special projects
• Act as 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 simultaneously taking notes and speaking with customers
• Perform other duties as assigned

Referral Specialist II – Part-Time

Auditor

• Audit inpatient medical records to ensure clinical documentation supports billed and reimbursed conditions and DRGs
• Review Diagnosis Related Group (DRG) paid claims
• Analyze and audit claims using medical chart coding principles, clinical guidelines, and objectivity
• Apply advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions
• Use audit tools, auditing workflow systems, and reference information to generate audit determinations and detailed audit findings letters
• Maintain accuracy and quality standards established by audit management
• Identify documentation and coding errors, including inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs)
• Suggest and develop concept, process improvement, and efficiency recommendations

DRG Clinical Validation Auditor – RN, CDI, MS-DRG, AP-DRG, APR-DRG

Financial Planning and Analysis

• Coordinate and lead the management reporting and analysis process
• Prepare financial and business analyses and research covering financial and expense performance, rate of return, depreciation, working capital, and investment
• Prepare budgets, forecasts, trend analyses, and analyses for sales, membership, cost of care, operating expenses, general business conditions, and related areas
• Conduct special financial and business-related studies
• Cooperate with other departments in preparing analyses
• Provide guidance to less experienced financial analysts

PBM Financial Analyst Lead

• Perform case management telephonically and/or through home visits within the 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 members’ identified needs
• Collaborate with providers

Behavioral Health Case Manager I

Nurse

• Review and make medical determinations as to whether claims meet the member's benefits
• Assess the necessity and reasonableness of items supplied in valid claims using medical policy and other materials
• Review and adjudicate claims
• Participate in required in-person training sessions and onboarding/skill development

Clinical Review Nurse I

Account Executive

• Maximize sales activity in a specified territory within home infusion therapy, infusion center, and related lines of business
• Consult and collaborate with key decision makers to achieve top-line revenue growth through new and renewal sales
• Develop and execute sales strategies to grow the market
• Proactively source and identify additional referral potential
• Create and modify training for new-hire associates and new drug launches
• Cultivate trust-based relationships and understand client needs and priorities
• Build relationships with pharmaceutical companies, patient advocacy groups, and industry-related non-profits
• Recommend adjustments to incentive design as the business evolves
• Lead internal partners in meeting or exceeding client expectations through customer service and continuous improvement
• Drive retention and growth opportunities
• Serve as an industry expert at the local and state level
• Stay informed of industry trends, competitors, and business threats
• Mentor team members and assist with onboarding new sales associates

Senior Account Executive – Infusion Sales

Customer Support

• Complete required basic training
• Respond to customer questions by telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims
• Analyze problems and provide information and solutions
• Operate a PC/image station to obtain and extract information
• Document information, activities, changes, and inquiry outcomes in databases
• Develop and maintain positive customer relations
• Coordinate company functions to handle customer requests and questions appropriately and promptly
• Research and analyze data to address operational challenges and customer service issues
• Provide internal and external customers with requested information
• Receive and place follow-up telephone calls and emails regarding routine customer questions
• Use computerized systems for tracking, information gathering, and troubleshooting
• Seek, understand, and respond to internal and external customer needs and expectations
• Handle calls, texts, facsimiles, and electronic queues while simultaneously taking notes and speaking with customers
• Perform other duties as assigned

Customer Care Representative I – Bilingual

Operations

• Own and advance the enterprise operating model for Responsible AI
• Establish AI governance across the full lifecycle, from intake and use-case assessment through retirement
• Translate Responsible AI principles into standards, controls, evidence requirements, and practical guidance
• Anticipate and operationalize federal and state requirements affecting AI, data, privacy, technology, and healthcare operations
• Partner with Legal, Compliance, Privacy, Risk, Government Affairs, and Internal Audit on enterprise requirements and controls
• Prepare the organization for regulatory inquiries, audits, examinations, and executive or board-level oversight
• Lead cross-enterprise decision forums across Legal, Compliance, Risk, Security, Data, Technology, Operations, and Business teams
• Define decision rights, escalation paths, service-level commitments, and accountability
• Redesign fragmented governance processes into integrated, technology-enabled workflows
• Use workflow automation, intelligent routing, reusable controls, evidence capture, dashboards, and AI-enabled decision support
• Establish performance baselines and improvement targets for review cycle time, aging, rework, exceptions, control effectiveness, and stakeholder experience
• Integrate AI and technology governance with enterprise risk, compliance, privacy, cybersecurity, data governance, model risk, third-party risk, and business continuity practices
• Enable associates and leaders to use AI safely through guidance, education, access controls, communications, and embedded support
• Define and report measures connecting governance to adoption, productivity, quality, risk reduction, member impact, and enterprise value
• Provide decision-oriented reporting to executives and governance bodies
• Establish an enterprise governance maturity roadmap and maintain an integrated policy, standard, procedure, and control library
• Build and lead a high-performing governance, risk, operations, automation, and Responsible AI team
• Lead a team of 7 direct reports and 25+ total FTEs

Staff Vice President – Enterprise AI Governance, Risk & Operational Excellence

Consultant

• Manage and support change management aligned with transformational business initiatives across the enterprise
• Embed user adoption through change management practices into business strategies
• Apply structured change management methodology to facilitate change and promote adoption
• Identify the need for agility and modify approaches to meet stakeholder needs
• Lead, coordinate, and provide visibility into engagement, communications, and training efforts for enterprise transformation initiatives
• Provide strategic consultation and execution to support adoption of change initiatives and necessary behavioral shifts
• Assess the magnitude and complexity of change, organizational readiness, and associated risks
• Conduct change-impact and stakeholder analyses
• Scan the environment to identify challenges and stakeholder resistance, including skills gaps, doubts, and uncertainties
• Create and deliver engagement and communications plans
• Solicit stakeholder feedback to measure change-management success and inform change strategies
• Collaborate with Culture Transformation, Communications, Human Resources, Technology, Global Service teams, and Enterprise Transformation leaders
• Apply enterprise standards across change interventions, including Responsible AI and internal best practices