Elevance Health

Manager

• Identifies potential issues, project change, and scope
• Leads efforts to identify best practices
• Identifies impacted parties, business partners, and resources required
• Develop and design processes and systems that support business needs
• Designs methods for integrating function and process
• Conducts cost/benefit analysis
• Builds support for business change throughout the business unit

Senior Business Change Manager - Payment Integrity

Vice President

• Own Carelon Health’s enterprise strategic planning process end to end
• Lead enterprise-wide transformation initiatives
• Design and manage the enterprise governance model for Carelon Health
• Serve as a strategic advisor and liaison to senior executives
• Integrate clinical, business, financial, and operational initiatives
• Conduct and oversee rigorous analysis of clinical, financial, operational, and market data
• Develop executive-level presentations and strategy materials
• Build a strategic ecosystem of internal and external partners
• Lead, coach, and develop a high-performing strategy and planning team
• Foster a culture of accountability and continuous improvement

Staff VP – Carelon Strategy, Execution

Security Engineer

• Develops strategic and tactical plans for a comprehensive enterprise-wide information security program
• Leads the development of security policies, technical standards, and guidelines
• Establishes architecture oversight and planning for information security technologies
• Leads development of information security risk management programs
• Participates in enterprise planning activity, including vendor assessment and technology platform selection
• Creates presentations and seeks approval for significant technology changes

Information Security Executive Advisor

Sales

• Developing and maintaining relationships with external clients and prospects
• Executing strategic sales and tactical plans on Stop Loss Bundled products
• Providing ongoing support to regional leadership
• Interacting directly with producer stop loss centers of excellence
• Assisting in the development of strategic producer relationships
• Partnering with leadership to develop key programs for growth and retention goals

Stop Loss Sales Manager

• Develops, recommends, and implements enterprise information security policies
• responsible for designing, implementing, and supporting enterprise key management and data protection solutions
• leads system and network architecture support for information and network security technologies
• leads development and execution of risk assessment methodologies
• develops security incident response plans and strategies
• designs & engineers comprehensive access management and network security technical solutions

Senior Information Security Advisor

• Responsible for care management for members with complex and chronic care needs
• Conduct assessments to identify individual needs and implement care plans
• Facilitate authorizations/referrals and coordinate internal and external resources
• Monitor and evaluate effectiveness of care management plans

Nurse Case Manager II

• Performing care management within the scope of licensure for members with complex and chronic care needs
• Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans
• Ensuring member access to services
• Conducting assessments to identify individual needs and care management plan
• Implementing care plan by facilitation authorizations/referrals
• Coordinating internal and external resources
• Monitoring and evaluating effectiveness of care management plan
• Interfacing with Medical Directors and Physician Advisors
• Assisting in problem solving with providers, claims or service issues

Telephonic Nurse Case Manager I

• 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 designed to optimize member health care
• Conduct assessments to identify individual needs and specific care management plan
• Facilitate authorizations/referrals as appropriate within benefits structure
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate effectiveness of the care management plan
• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans
• Assist in problem-solving with providers, claims or service issues

Nurse Case Manager I

Pharmacist

• Verify member and prescriber information
• Enter accurate data to support pharmacists and clinical programs
• Educate members on pharmacy-related rules
• Conduct phone and text-based outreach to members and providers
• Provide support for grievances and appeals inquiries
• Generate and maintain reports and records

Pharmacy Technician II

• Completes and submits re-authorizations for patients
• Enters re-authorizations into the portal with accuracy
• Maintains log of all re-authorizations submitted
• Follows up with insurance companies for approval/denial status

Authorization Representative I – BioPlus Specialty Pharmacy

• Develops and maintains positive customer relations
• Interacts with internal and external customers
• Responds to client issues via telephone and written correspondence
• Completes necessary research to provide proactive, thorough solutions
• Supports and guides the customer with their personal options and decisions

Pharmacy Customer Associate II

• Assists in developing and configuring prior authorization decision trees in the workflow tool
• Participates in quality assurance feedback from pharmacists of prior authorization decision trees within the workflow tool
• Assists in implementing clinical programs within the prior authorization space
• Verifies member, provider, and drug information and inputs data for the prior authorization pharmacists
• Educates providers on pharmacy-based rules related to prescriptions and medication resources or assistance programs
• Processes prior authorization requests from physicians’ offices and ensures compliance with Medicare and Medicaid requirements; inform relevant parties of all prior authorization determinations

Pharmacy Intern

Consultant

• Establishes, improves, and optimizes the consolidating processes for forecast and month-end results
• Consolidates and prepares executive summary reports for various business segments in the SBU for top management decision-making
• Analyzes and designs solutions to address varied and highly complex business needs
• Collaborates with businesses and technical areas to implement new or enhanced products
• Has strong knowledge of products as well as our internal business models and data systems
• Coordinates with external audits as appropriate
• Acts as the central contact with internal departments and external auditors

Senior Business Information Consultant

Claims Specialist

• Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made.
• Researches and analyzes claims issues.
• Learning the activities/tasks associated with his/her role.
• Works under direct supervision.
• Relies on others for instruction, guidance, and direction.

Claims Processor I

• Hires, trains, coaches, counsels, and evaluates performance of direct reports
• Adheres to the best practice model for all facets of program operations
• Collaborates with management team to support alignment across coordination teams
• Mentor direct reports to apply Independence First principles through appropriate service allocation determinations
• Ensures adequate coverage for all tasks and job responsibilities
• Coordinates service delivery of assigned team to include member assessments, care planning, and ongoing contacts
• Participates in cross-functional workgroups to maintain and enhance the program
• Evaluates current processes of Special Program's support functions; recommends changes for increased efficiencies and improved outcomes
• Identifies training needs for coordination teams
• Effectively communicates risks, status of team performance, and support needs to leadership
• Utilizes performance data to support team with consistent compliance with key program metrics