Elevance Health

Strategy

• Understands all aspects of the business and partners with executive leadership to define strategy and successful criteria for the future
• Translates strategy into defined tactics, programs/projects priorities, and timelines
• ensures alignment and attainment of enterprises strategic plans to turn strategy into reality
• Documents strategic priorities such as external environment and reports on customer insight research initiatives
• Builds and leverages relationships to provide innovative solutions to complex business problems
• Proposes opportunities to improve results based on continuous needs assessment
• Responsible for the development implementation and monitoring of line of business planning and project activities
• Leads and/or supports project/program execution as required

Business Strategy Plan Director

Customer Support

• Act as a trusted advisor and educator on health care related inquiries.
• Guide customers to a better healthcare experience, resolving questions and concerns.
• Partner internally to create a seamless experience for customers and resolve issues.

Customer Care Representative I, Bilingual – Spanish

Content Writer

• Provide writing support for the development and implementation of provider communication materials
• Consults with business owners to clarify content needs
• Writes, edits, and reviews content for various materials (printed and digital)
• Ensures compliance with internal and external standards
• Identifies improvements to support operational excellence

Provider Comm Writer

Financial Planning and Analysis

• supporting all month-close functions
• closing, analysis, reporting
• providing project leadership
• preparing financial, business and process presentations
• coordinating, managing and leading complex projects and processes

Financial Accounting Analyst

Manager

• performing care management for members with complex and chronic care needs
• assessing, developing, implementing, coordinating, monitoring, and evaluating care plans
• conducting assessments to identify individual needs
• facilitating authorizations/referrals
• coordinating internal and external resources
• monitoring/evaluating effectiveness of care management plans
• interfacing with Medical Directors and Physician Advisors
• assisting in problem solving with providers

Nurse Case Manager I

Analyst

• Accurate and prompt credentialing for health plans and pharmacy benefit managers (PBM) for all pharmacy sites
• Acts as a troubleshooter in resolving payor departmental issues related to credentialing
• Manages and maintains pharmacy license tracking tool to advise pharmacy sites and pharmacists of license renewals
• Maintains confidentiality of all pertinent pharmacy and provider information
• Administers credentialing and re-credentialing to ensure compliance with regulatory, accreditation and various managed care plan policies and protocols, standards, and requirements
• Develops and fosters collaborative relationships with managed care plans, state agencies and PBM’s to facilitate timely credentialing and re-credentialing of applications
• Tracks credentialing and re-credentialing to ensure compliance with time sensitive materials
• Maintains all pharmacy site credentialing and re-credentialing files, electronic and paper
• Effectively communicates with admission, billing, and clinical teams in a professional manner
• Reviews all credentialing policies and procedures for accuracy and completeness
• Suggests revisions of policies and procedures when necessary
• Completes new Medicaid applications and renewals or revalidations
• Medicaid portal maintenance and updates
• Medicaid administrator user access for billing
• Pull Medicaid remits for billing team upon request if portal access is limited
• Manage PBM credentialing requests and maintenance
• Medicare (PECOS) processing for all pharmacy sites
• Maintain NCPDP profile for all pharmacy sites
• Certificate of Insurance requests and dissemination to plans or CMS
• NPI profile updates (NPPES)
• URAC, ACHC, NABP support during accreditation renewals
• Fraud, Waste and Abuse annual attestation submission to health plans
• Manage pharmacy Continuing Education Units for RFP’s
• Pull and maintain credentialing documents for payor applications

Credentialing Analyst, Pharmacy

Director

• Develop end-to-end M&A integration strategy from due diligence through execution
• Lead large, multiple deal teams through complex integration programs
• Define and execute programs with executive leaders
• Build detailed execution plans to realize deal value
• Oversee integrations to ensure alignment with enterprise strategy
• Identify and implement cross-team process improvements
• Advise business leaders on future-state strategy and operating models
• Partner with Legal to ensure compliance with deal parameters
• Build relationships with stakeholders for effective integration

Integration Strategy Director

Learning and Development

• Responsible for facilitating a variety of performance-based learning events
• Delivers synchronous and asynchronous learning events using varied media in virtual and global environments
• Employs rapid course development methodologies to quickly meet client needs
• Exercises classroom management including learner performance
• Measures, tracks and evaluates learner and client satisfaction
• Thinks and acts globally and is aware of learning and cultural differences
• Keeps technical skills updated
• Travels to worksite and other locations as necessary

Training Specialist

• Responsible for ensuring effective psychosocial intervention, positively impacting a patient's ability to manage his/her chronic illness
• Utilizes available community, government, and/or client resources needed to address participant's limitations
• Manages behavioral and psychosocial needs that result in improved clinical and financial outcomes
• Assists members to effectively utilize available resources to meet their personal health needs
• Evaluates members' ability to independently manage self and locate alternative resources
• Provides guidance to members seeking alternative solutions to specific social, cultural or financial problems
• Evaluates members' strengths related to health self-management
• Facilitates and coordinates behavioral health resources as individual member needs are identified

Social Work Case Manager

Data Entry

• Verifies member information and inputs data for the pharmacists
• Educates members 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 requirements
• Provides resolution to grievances and appeals issues
• Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits

Part-Time Pharmacy Technician I, Data Entry – Advanced Home Delivery

Administrative Assistant

• Provides administrative support to an individual or department
• Maintains general files
• Orders supplies
• Screens phone calls
• Coordinates meetings
• Compiles and distributes meeting minutes
• Coordinates travel plans
• Submits expense reports
• Compiles, collates, assembles meeting/presentation materials
• Utilizes various software packages to produce professional quality reports, letters, presentations and other documents
• Performs various technical support duties such as information gathering, reporting, tracking and researching
• Organizes chart updates
• Receives and responds to routine correspondence following established procedures

Administrative Assistant I

• Collaborating with healthcare providers and/or consumer to drive personalized health management
• Performing care management activities within the scope of licensure for members with complex and chronic care needs
• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out of network services, and appropriateness of treatment setting and level of care
• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance
• Collaborating with providers to assess consumer needs for early identification of and proactive planning for discharge
• Conducting clinical assessment to develop goals that address individual needs in order to develop and implement a care plan
• Monitoring and evaluating effectiveness of the care management plan and modifies as necessary

Nurse Care Manager I

• providing high level administrative support to an individual or department
• Researches and verifies information pertaining to reports
• prepares/tracks budgets
• creates databases and analyzes moderately complex data
• Supports projects by assisting manager/department
• builds and maintains project plans
• schedules and contributes to meetings to ensure project deliverables are met
• Prepares correspondence and reviews documentation for conformance with internal policies and procedures
• May maintain files, orders supplies, coordinates meetings and compiles and distributes meeting minutes
• Handles travel arrangements and expense reports
• May screen, handle or distribute incoming calls and complaints

Administrative Assistant II

• Responsible for supporting the development, implementation, and coordination of a comprehensive health care program in which members' needs are identified, including physical health, behavioral health, social services for CFSP Foster Care.
• Directs and oversees program operations in support of corporate and health plan management.
• Directs and collaborates with functional managers to develop and implement the steps necessary to manage program operations.
• Participates in cross-functional workgroups created to maintain and develop program.
• Evaluates program operations to improve efficiency of operations, financial return, customer service, and provider engagement.
• Develops, communicates, and monitors program schedule, budget, and resources plan.
• Manages resource utilization to ensure appropriate delivery of care to members and adequate coverage for departmental tasks and job responsibilities.
• Hires, trains, coaches, counsels and evaluates performance of direct reports.

CFSP Licensed Manager II, Complex Medical/IDD

Account Executive

• Responsible for achieving client retention by developing deep familiarity with all aspects of client contracts including products, service levels, and client KPIs
• Partner with key stakeholders to develop account plans for each client
• Identify and execute cross-sell opportunities to achieve gross margin and EBITDA targets
• Develops business relationships with key decision makers and ensures client satisfaction
• Takes a lead role in client meetings, upsells and RFPs / Rebids
• Serves as a key client contact for independent resolution and innovation for client executive teams
• Coaches Account Managers as needed
• Lead and influence communications with client leadership on company value proposition and alignment to client strategy