Elevance Health

Manager

• Managing a team of physical and/or behavioral health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review
• Ensuring compliance with global program elements as well as contractual or regulatory requirements
• Developing and implementing workflows and protocols in compliance with global programs and regulatory guidelines
• Assisting in identifying opportunities to improve operational efficiencies, clinical quality, and solution performance
• Analyzing solution specific reports identifying trends over time
• Coordinating service delivery to include member assessment of physical and psychological factors
• Partnering with providers to establish short and long-term goals that meet the members’ needs, functional abilities, and referral sources requirements
• Identifying members with potential for high-risk complications
• Reviewing benefit systems and cost benefit analysis
• Evaluating medical, mental health and substance abuse service for cost containment
• Supporting program compliance and assisting in identifying opportunities to improve the customer service and quality outcomes
• Supporting quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting
• Hiring, training, coaching, counseling, and evaluating performance of direct reports

Manager I – Maternal, Child, and Women’s Health Care Management

Business Analyst

• Ensure the best possible call center service levels are achieved to maximize utilization
• Monitor call volume demand in real time and flex workforce accordingly
• Adjust schedules to ensure consistent service is maintained
• Manage and adjust call routing when unusual call patterns exist
• Update schedules to ensure statistical staffing requirements are met

Workforce Management Analyst

Product Manager

• Understands the customer needs and participates in validation of proposed solutions
• Collaborates to continuously develop and communicate the vision for the scrum teams
• Manages the program Epic/Initiative backlog at the Agile Lean Program Level
• Partners with the stakeholders to develop the business case for Epics/features that affect the Agile Release Train (ART)
• Utilizes the right key performance indicators (KPIs) to measure the product performance
• Supports portfolio work including budget parameters and strategic themes
• Advocates for current and future funding and drives requests for funding and secures budget for the continuous flow of value to customers
• Collaborates with the system and solution architects to assist with decision-making and sequencing of the key technical aspects to support the new business functionality
• Builds an effective product manager/product owner team for multiple trains in support of their value stream
• Mentors Product Managers to confidently drive solutions across teams
• Designs and runs evaluations to assess product performance
• Applies Agile at scale
• Manages backlog management, sprint planning, and writes clear user stories, acceptance criteria, and evaluation frameworks
• Launches and scales products in complex or regulated industries
• Codes/prototypes to validate ideas and accelerate innovation

AI Agile Product Manager

• Responds to complex cases and account specific requests
• Uses screening criteria and clinical judgment to assess member needs
• Conducts assessments and develops care plans
• Monitors and evaluates effectiveness of care plan
• Coordinates with resources to meet member needs

Behavioral Health Case Manager II

Consultant

• Calculates stop loss rates for large complex cases based on thorough analysis of experience, location, demographics, etc.
• Coordinates with other departments to ensure accuracy and consistency of overall account reporting.
• Proposes rates for prospective business utilizing a combination of other carrier experience, demographic data and manual rates.
• Performs post-sale reviews.
• Prepares or supervises preparation of annual settlements, rate projections, or benefit change increments and decrements.
• Surveys existing product portfolios by market, monitors sales results, trends and needs, recommends product portfolio changes.
• Assists in establishing rating and administrative procedures.
• Participates in major multi-functional teams as underwriting representative.
• Assists in the technical development of underwriting associates, which may include monitoring reports and work flow to provide recommendations on productivity and efficiency improvements.
• Updates and monitors departmental processes and procedures in compliance with system, regulatory and business requirements.

Senior Stop Loss Group Underwriter Consultant

Clinical Operations

• Assists in the development of new clinical products
• Oversees the Prior Authorization Center
• Implements new prior authorization program
• Manages clinical pharmacy operations and staff to ensure clients' objectives and deliverables are met
• Oversees departmental processes, policies and procedures, training, and communication
• Reports and analyzes prior authorization program trends
• Ensures achievement of department goals and objectives
• Hires, trains, coaches, counsels, and evaluates performance of direct reports
• Provides clinical consulting services to client and implements clinical information and education programs
• Assists in developing formularies
• Performs drug utilization analyses
• Participates in and presents to Pharmacy and Therapeutics (P&T) committee meetings and management of client formulary

Manager, Pharmacy Clinical Operations – Prior Authorization

Events

• Provides advanced level engineering design for DLP and Data Discovery/Classification tools
• Ensures and reviews appropriate testing practices for current and future state technologies
• Reviewing and investigating results from deployed technologies to provide key data points to other Information Security programs
• Assisting in process and project management
• Provide required information for audit and compliance
• Represents major upgrades and business system replacements to leadership
• Establishes vendor relationships for DLP and Data Discovery/Classification products and services
• Provides technical guidance and leadership to Program engineers
• Ensures security solutions involving the use of technologies are well-conceived, designed and implemented in compliance with enterprise standards
• Develops testing plans to ensure quality of implementation

Data Loss Prevention, DLP Advisor

People Operations

• Partners closely with People Strategy Partners to lead short-term, high-impact projects integrating organization design, workforce analytics, talent optimization, and change enablement
• Serves as a guiding force for junior problem solver roles, playing a pivotal part in crafting, implementing, and refining organizational policies
• Acts as the execution engine behind strategic people strategies by building scalable solutions and creating reusable playbooks for replication across business units
• Diagnoses and frame organizational problems through stakeholder interviews, data analysis, and root cause synthesis
• Designs and co-creates evidence-based solutions alongside HR and business teams utilizing best practices, analytics, and iterative feedback
• Lead agile sprint execution, managing timelines, deliverables, retrospectives, and ensuring stakeholder alignment

Senior People Enablement Partner

• Manage and balance sprint work to align with complexity, risk, and strategic priorities while maintaining quality and scalability.
• Guide enterprise demand for People Enablement services, translating business priorities into actionable work and ensuring efficient prioritization.
• Manage enablement work from inception to delivery, establishing clear scopes and removing obstacles to sustain progress.
• Act as a communication hub, providing ongoing updates on project status and risks, and ensuring cohesive messaging across HR roles.
• Ensure effective adoption of solutions and capture lessons learned to refine future initiatives.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Director, People Enablement

• Deliver on the LTSS commitment to linking provider payment to improved performance
• Support the design and modification of LTSS VBPs based on stakeholder feedback and utilization
• Partner with the state, other LTSS contractors, and stakeholders for VBP methodologies
• Advise on innovative programming for the health plan
• Responsible for provider training, technical assistance, and performance monitoring related to VBP offerings
• Define key VBP performance indicators and deliver program performance to providers
• Establish standard measures for all provider feedback reports
• May coordinate negotiated contracts for providers
• Function as a technical resource for complex provider issues
• Coordinate Joint Operation Committees (JOC) of larger provider groups
• Identify and report on provider utilization patterns
• Conduct provider refresher training as needed
• Research issues impacting future provider negotiations or network retention

Senior Network Relations Consultant – Value-Based Program Specialist

Program Manager

• Own and operate HR development programs end-to-end, including program design, governance, annual planning, refresh cycles, and day-to-day management
• Maintain program consistency and quality at scale by establishing clear standards, processes, documentation, and execution cadences across business units and stakeholders
• Manages program governance and approvals, including business and HR Stakeholder alignment, change management for program updates, and risk/compliance considerations
• Coordinate and enable program-related training and communication to drive understanding, adoption, and consistent application across the business
• Partner with COE to define and track program success measures, including participation outcomes, and effectiveness metrics; conduct regular assessments and recommend enhancements based on data and feedback
• Partner with HR COEs and business leaders to ensure programs integrate seamlessly with broader talent, learning, and workforce strategies

HR Program Manager

• Manage psychiatric and substance abuse disorder facility-based and outpatient professional treatment health benefits
• Assess member needs to ensure access to medically necessary quality behavioral healthcare
• Refer cases to Peer Reviewers as appropriate
• Perform psychiatric and substance abuse disorder assessment coordination, implementation, case planning, monitoring, and evaluating
• Promote quality member outcomes and optimize member health benefits

Behavioral Health Care Manager I

• Partners closely with People Strategy Partners to lead short-term, high-impact projects integrating organization design, workforce analytics, talent optimization, and change enablement.
• Acts as the execution engine behind strategic people strategies by building scalable solutions and creating reusable playbooks for replication across business units.
• Diagnoses and frame organizational problems through stakeholder interviews, data analysis, and root cause synthesis.
• Designs and co-creates evidence-based solutions alongside HR and business teams utilizing best practices, analytics, and iterative feedback.
• Lead agile sprint execution, managing timelines, deliverables, retrospectives, and ensuring stakeholder alignment.

People Enablement Partner

Customer Support

• Customer Care Representative I, II, III
• The Customer Care Rep I is responsible for successfully completing the required basic training.
• Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues.
• Must pass the appropriate pre-employment test battery.
• The Customer Care Rep II is responsible for responding to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.
• Proficient in all basic customer service areas performs some but not all types of moderately complex function.
• The Customer Care Rep III is responsible for reviewing requests by mail, telephone, or in person regarding insurance claims/policies.
• Fully proficient in all key areas; performs many complex functions.
• All Levels: Outbound calls are conducted in the ZipDrug business area. Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.