Elevance Health

Medical Director

• Medical Director responsible for the administration of physical and/or behavioral health medical services.
• Ensure the appropriate and most cost-effective medical care is received.
• May be responsible for developing and implementing programs to improve quality, cost, and outcomes.
• Provides clinical consultation and serves as clinical/strategic advisor.
• Identifies cost of care opportunities.
• Serves as a resource to staff including Medical Director Associates.
• Conducts peer-to-peer clinical reviews and may represent the company to external entities and/or serve on committees.

Financial Planning and Analysis

• leading the process of preparation and interpretation of complex financial analysis for Medicare lines of business
• end to end ownership/management of business processes
• drive holistic and consistent solutions
• monthly Close and Forecasting, as well as ad hoc analysis
• focuses on business process improvement initiatives
• creates innovative financial system solutions
• strong financial and data analysis using Advanced Excel
• consults with management and provides solutions and recommended actions
• provides guidance and training to less experienced team members
• conducts and documents complex financial and business-related analyses and research fields
• provides detailed analysis and reporting for leadership

Financial Consultant Manager

• Prepares budgets, forecasts, trend analyses and expense accruals
• Provides information for various monthly journal entries and partners with Accounting team to ensure accurate booking to the general ledger
• Compiles and prepares standard/recurring and ad hoc financial reports
• Creates trend reporting related to revenue and various benefit expense items
• Coordinates and partners with associates across multiple teams including Finance, Accounting, Actuarial, business team for research and solutions
• Leads meetings with stakeholders, documents solutions / next steps, and presents results

Senior Financial Analyst

Manager

• responsible for managing autism services and behavioral health treatment benefits through written review
• Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral healthcare
• Refers cases to Peer Reviewers as appropriate
• Performs ABA initial treatment assessment reviews and treatment monitoring and evaluating to promote quality member outcomes
• Will serve as a resource to other BH Care Managers
• Assists with more complex cases and may participate in inter and intradepartmental teams projects and initiatives

Behavioral Health Care Manager II

Systems Engineer

• Defining and managing the scope of business systems projects
• Managing integrated functionality, usability, reliability, performance and support requirements of a system
• Creating feature test strategies and environment needs
• Providing the link between the technical and business views of the system
• Ensuring that the technical solutions being developed will satisfy the needs of the business
• Anticipating and identifying opportunities for improvement
• Ensuring high level designs including architecture requirements are accurately documented and map to approved requirements
• Assisting in developing training documentation and proactive identification of additional documentation needs
• Proactively working with stakeholders to identify future system opportunities and enhancements
• Developing use cases

Senior Systems Analyst

Engineer

• Design, develop, and implement robust, reusable full-stack applications
• Participate in and perform technical design reviews and code reviews
• Define application scope, objectives, and technical specifications
• Collaborate with cross-functional partners
• Facilitate sessions for requirements clarification, technical design discussions, and troubleshooting complex issues
• Work closely with product teams to plan and prioritize development work
• Create and maintain technical documentation
• Plan, schedule, and implement change deployments
• Investigate major incidents and drive faster resolutions
• Provide release and production support
• Assess current system status and support data planning
• Mentor team members and lead small projects
• Stay current with industry trends and emerging technologies

Senior Engineer

Compliance

• Function as point of contact for member and provider complaints received by the Ohio Medicaid Regulator.
• Process regulator Ad Hoc inquiries, and coordinates and tracks collateral submissions as required by the state contract.
• Additional internal responsibilities include policy reviews, regulatory grid completion and job aid development and updates.
• At the most senior advanced level, report, communicate, research laws, regulations, requirements, regulatory audits and/or exams.
• Provide senior level analytical support to projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments.
• Utilize systems unique to job functions, including standard-issue software such as Microsoft products; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance.
• Apply critical thinking to formulate strategies and concepts that drive results, persuade and influence others, adapt to change, and manage conflict.

Senior Compliance Consultant

Customer Support

• Provides oversight for customer service staff
• Establishes departmental policies and procedures
• Directs implementation and administration of benefit programs
• Prepares and communicates information regarding benefit programs
• Audits to monitor efficiency and compliance with policies
• Prepares specialized reports
• Hires, trains, coaches, counsels, and evaluates performance of direct reports

Manager I, Customer Care – FEP

Technical Program Manager

• Responsible for the development and ongoing management of multi-year programs
• Manage enterprise-wide programs of $7M–$10M+ size
• Apply project management knowledge, skills, tools, and techniques to project deliverables, processes, and systems
• Coaching and mentoring project team members
• Developing resource, risk, quality, cost, and scope management plans
• Identify opportunities for cost optimization and synergy realization

Technical Program Manager – Integration Management Office

• Determines the medical necessity of requests using clinical criteria
• Performs physician-level case review of oncologic utilization requests
• Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, procedures, imaging and appropriate sites of service
• Provides education regarding applicable clinical criteria and discusses clinically appropriate options
• Performs first level provider appeals for coverage decisions
• Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate diagnoses, treatments, and management related to these specialties
• Participates in physician team meetings
• Participates in groups that develop, revise and enhance clinical appropriateness guidelines

Medical Director – Genetic Testing, Oncology

Director

• Responsible for developing strategies, programs and solutions based on business priorities, consumer insights and industry trends that support digital strategy
• Responsible for researching and evaluating new digital market concepts / solutions and determining if and how they would best fit into the existing portfolio of services
• Develop strategic roadmaps, competitive benchmark assessments, and identify or evaluate potential solutions that could support the market offer
• Works with business partners and foster multidisciplinary collaboration to both create business cases and ensure the deployment of solutions that engage target populations and address market needs
• Partners with leaders and associates in the broader enterprise digital solutions organization to align priorities and strategies
• Responsible for gathering and assessing market requirements through competitive intelligence and emerging trends, stakeholder and consumer feedback

Digital Solutions Director

General Counsel

• Provide legal guidance on federal and state Medicaid laws, regulations, and compliance requirements
• Review contracts
• Support regulatory filings
• Ensure alignment with evolving Medicaid rules
• Handle audits and inquiries from oversight agencies

Medicaid Legal Counsel

• Have program management responsibilities including clinical policy development
• Oversee clinical/non-clinical activities
• Responsible for utilization review/management
• Develop and implement programs to improve quality, cost, and outcomes
• Conduct peer-to-peer clinical reviews with attending physicians
• Serve as a resource and consultant to other areas of the company
• Interpret medical policies and clinical guidelines
• Lead and develop clinical and non-clinical activities

Cloud Engineer

• Collaborate with product managers, security teams, and other stakeholders to define infrastructure and platform requirements and delivery timelines.
• Develops and review infrastructure code, enforce best practices, and ensures compliance with security standards.
• Support sprint planning, task allocation, and operational performance tracking.
• Creates and updates Infrastructure as Code (IaC), CI/CD pipelines, Ansible, Packer, Python, and cloud-native automations.
• Automates management of cloud networks (VPC/VNet), Transit Gateways, DNS, Onpremise Connections, Load balancers, Web Application Firewall (WAF) configurations, certificates, and automations for web applications.
• Automates management of cloud security controls - NSGs, IAM roles, policies, etc. to comply with Elevance Health standards.
• Leads disaster recovery designs and automations for cloud deployed components.
• Leads the ITIL processes - incident, request, change management and may coordinate with other teams as necessary.
• Maintains active relationships with customers to determine business requirements and leads requirements gathering meetings.
• Owns the change request process and may coordinate with other teams as necessary.
• Provides technical advice and weighs in on technical decisions that impact cross-functional teams.
• Develops and owns list of final enhancements.

Senior Cloud Platform Engineer

Product Designer

• Collaborates with business partners on expected business outcomes.
• Participates in needs analysis and recommends effective learning solutions.
• Works collaboratively with other content developers, graphic designers, technology consultants, technologists, and other project team members.
• Uses all approved processes, tools and templates to standard for development and reporting.
• Actively maintains all content.
• Participates in quality review process.
• Participates in and contributes to Learning & Development sub-teams, communities of practice, and other opportunities to enhance knowledge and skill.

Medical Director

Financial Consultant Manager

Senior Financial Analyst

Behavioral Health Care Manager II

Senior Systems Analyst

Senior Engineer

Senior Compliance Consultant

Manager I, Customer Care – FEP

Technical Program Manager – Integration Management Office

Medical Director – Genetic Testing, Oncology

Digital Solutions Director

Medicaid Legal Counsel

Medical Director

Senior Cloud Platform Engineer

Learning Experience Designer II