Elevance Health

Full-stack Engineer

• responsible for full stack development and maintenance of web applications interfacing to our enterprise AI platform
• maintain active relationships with customers to determine business requirements
• leads requirements gathering meetings and reviews designs with the business
• implement improvements in stability, performance, and scalability across major business-critical systems
• own the change request process and coordinate with other teams
• develop and own a list of final enhancements
• develop and define application scope and objectives and supervise technical and/or functional specifications
• perform technical design reviews and code reviews
• ensure unit test is completed and meets test plan requirements
• coordinate and manage on-call support and own the system monitoring process
• lead multiple or large projects and facilitate large group JAD sessions for requirements

Full Stack Engineer – Lead

Director

• Partner with key internal and external stakeholders to drive value and innovation through formulary strategy development and optimization.
• Present contract scenarios and opportunities to internal stakeholders and health plan and client decision-makers across multiple lines of business to gain alignment on strategy and implementation.
• Ensure that formulary and contract strategy aligns with overall strategic objectives.
• Collaborate with internal and external partners to develop and implement future revenue, formulary product portfolio expansion and membership growth initiatives.
• Provides consultative support to sales and account management partners, including development of strategies to win new business and retain current clients by increasing rebates and supporting the sales process.
• Build solid and collaborative relationships with pharmaceutical manufacturer partners.

Formulary Strategy Development Director

Auditor

• Leads day-to-day activities of the audit team
• Creates and manages workflow assignments
• Establishes priorities and serves as a resource for training lower-leveled audit associates
• Operates as the SME (subject matter expert) for a specific line of business
• Documents workflow processes
• Collaborates across business lines through the facilitation of meetings
• Manages vendor relationships with contracted vendors
• Investigates potential fraud and over-utilization by performing complex medical reviews
• Conducts provider meetings to discuss audit findings and appeals
• Researches claims payment methodologies and fee schedule pricing
• Adjusts and re-prices claims per audit findings
• Assists in resolving contractual issues with providers
• Prepares and analyzes various reports

Provider Auditor Lead – Payment Integrity, Clinical Audit

Consultant

• Conduct detailed evaluations of provider practices to determine their current capabilities in value-based care and identify key areas for growth and improvement.
• Engage in a continuous process that includes assessment, root cause analysis, strategy development, implementation, and outcomes tracking for each provider.
• Assist providers with executing action plans focused on population health management, patient satisfaction, and optimizing quality and cost performance.
• Lead collaborative meetings with provider staff and internal stakeholders to ensure alignment and successful deployment of strategic initiatives.
• Create and deliver tailored learning opportunities to aid providers in implementing recommended interventions effectively.
• Educate providers on using proprietary tools, data, and technology to improve performance in critical metrics, driving effective and efficient care.
• Utilize data analytics to continuously monitor and track the key performance metrics for assigned providers, ensuring data-driven decision-making.
• Accurately document all action plans, interventions, and provider activities in Salesforce to maintain comprehensive records and reporting capabilities.
• Cultivate and maintain strong, long-term relationships with physicians, providers, and healthcare systems to support financial and quality improvements within the health plan contract.
• Advise executives on developing segment-specific strategies in areas such as financial performance, incentive programs, quality management, and other operational areas impacting provider success.
• Exercise independent judgment on complex issues, working under minimal supervision to evaluate variable factors and determine optimal courses of action.

Senior Care Consultant, Provider Success

Manager

• Manage clinical program development for population-based clinical quality measures, including HEDIS within a clinical area and across all lines of business
• Oversees vendor contracts, negotiations and service-level agreements and continuously monitors vendor performance
• Ability to create workflows, prioritize work and manage multiple projects while meeting deadlines
• Evaluates industry best practices, medical research and other resources to develop clinical programs and tools which facilitate and support quality, cost-effective care
• Develops and implements an annual plan detailing the strategies, programs and tools to be implemented
• Leads program development activities
• Develops and coordinates presentations, communications and implementation for all phases of the clinical programs/tools development and implementation
• Ensures all programs and tools are compliant with regulatory directives and state/federal laws and policies
• Identifies system needs to implement clinical programs
• Develops system requirements and ROI
• Tracks program performance and results and modifies as needed
• Provides leadership and guidance to associates involved in program development and implementation activities

Clinical Program Development Manager

• Conducting financial/operational audits.
• Internal control assessments.
• Strategy reviews.
• Special projects and risk assessment activities.
• Lead the development and execution of high quality assessments of the Company’s complex processes and controls.
• Identify risks and collaborate with team leadership, business management and external auditors on audit planning, testing and evaluation procedures.
• Prepare clear, accurate and concise audit work papers.
• Present findings/deficiencies to the lead auditor with recommendations for remediation.
• Review work performed by others and provide recommendations for improvement.
• May support internal and external audit/compliance groups with various activities.

Senior Internal Auditor

• Telephonic Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
• Performs duties telephonically for discharge planning.
• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.

Nurse Case Manager

Underwriter

• Calculates proposed rates for large complex prospective cases based on thorough analysis of other carrier experience, location, demographics, etc.
• Coordinates with other departments to ensure accuracy and consistency of overall account reporting.
• Performs post-sale reviews.
• Prepares or supervises preparation of annual settlements, ERISA reports, 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.

Senior Group Underwriting Consultant

• Responsible for 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 designed to optimize member health care across the care continuum
• Conduct assessments and coordination of care telephonically and occasionally on-site
• Ensure member access to services appropriate to their health needs
• Conduct assessments to identify individual needs and develop care management plans
• Implement care plans by facilitating authorizations/referrals as appropriate
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate effectiveness of care management plans and modify as necessary
• Interface with Medical Directors and Physician Advisors on care management treatment plans

RN Case Manager – Telephonic, Field

• Providing nutritional/dietary consultations to participants in the patient management programs
• Ensures patient understanding of nutritional goals and objectives
• Provides nutritional counseling and patient education for patients diagnosed with chronic conditions
• Motivates patients to make changes or enhancements to their current nutritional plan
• Collaborates with physicians or other health professionals to ensure adherence to prescribed plan of care
• Develops training modules for nurse consultants providing care management services for participants

Nutritional Consultant

Architect

• works with business and technology stakeholders to build a holistic view of the organizations strategy, processes, information and technical assets
• define IAM target-state architecture, reference architectures, and roadmaps
• select and design integrations for IAM platforms (e.g., Entra ID/Azure AD, Okta)
• integrate authoritative sources with directories and downstream apps
• design IAM for AWS/Azure/GCP (roles, policies, identities, workload identity, least privilege)
• partner with platform/DevOps teams on secrets management, key management, and CI/CD access patterns
• define logging, monitoring, and audit controls for IAM events
• lead threat modeling and remediation for identity-related risks
• recommends new technologies for domains based upon business value drivers and return on investment
• establishes overall systems architecture vision and ensures specific components are appropriately designed and leveraged
• contributes to the holistic vision of Enterprise Architecture
• takes responsibility for health of overall architecture for market segment
• maintains components of architecture strategy and vision
• coordinates all enterprise-level conceptual architecture components (e.g., data architecture, application architecture, technical architecture)
• monitors usage of architectural components and assumes responsibility for reuse
• drives system migration based upon roadmaps defined in enterprise and domain blueprints
• leads architecture strategy and vision for enterprise
• ensures blueprints are refreshed as needs emerge or in accordance to plan of record changes
• provides continuous consulting services and direction in projects and architectures
• champions and responsible for enterprise level technology and architectural standards, guidelines, principles, frameworks, and reference models
• defines systems, technical, and application architectures for new strategic initiatives; develops and maintains an architectural blueprint and evolutionary roadmap that defines and communicates the strategic direction for these architectures in support of business and technical strategies

Identity & Trust Architect

Financial Planning and Analysis

• Completes highly complex account reconciliation
• Prepares internal and external monthly, quarterly and annual financial reporting and analysis
• Verifies the integrity of monthly results by completing various analyses and interpreting the data

Senior Financial Accountant

• The Solutions Management Manager is responsible for leading the planning and implementation of products and services for a line of business enterprise wide.
• Provides consultation and advice to business partners regarding benefits of products and analytics.
• Explains timelines and measures of success for implementing these products.
• Coordinates with the Physician Liaison regarding clinical issues related to clinical measure implementation or customization by line of business and communicates changes to Product Development for consideration in product performance and financial analyses.
• Schedules and coordinates implementation of contracted products and services for assigned business partners.
• Coordinates data requirements, production schedules, and deliverables with the business partner.
• Oversees all business partner specifications and/or modifications for contracted products and services.
• Provides business partners with the resources, training, and services necessary to effectively utilize the products that the department provides.
• Analyzes business partner data for QA and identification of opportunities for business partners to utilize products and services to improve plan performance.
• Maintains detailed knowledge of current clinical measures and future clinical measure development plans, communicates this information to business partners, assists in the selection of clinical measures to be utilized in pilot and full rollout of products and services, and guides business partners in continually reviewing and updating clinical measure sets.
• Maintains detailed knowledge of all current systems, products, and services and a basic understanding of future system and product development plans to allow an appropriate level of communication with business partners.
• Leads department projects and mentors solutions management staff.

Solutions Management Manager

• Creates and maintains databases to track business performance.
• Analyzes data and summarizes performance using summary statistical procedures.
• Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data)
• Provides notations of performance deviations and anomalies.
• Creates and publishes periodic reports, as well as any necessary ad hoc reports.
• Takes business issues and devises best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.
• Makes recommendations based upon data analysis.
• Provides analytic consultation to other business areas, leadership, or external customers.
• Performs data analysis and reporting encompassing higher levels of complexity.

Business Information Consultant

Clinical Research

• Executes statistical analyses plans independently
• Collaborates with project team members to implement the study design and statistical analyses plans
• Conducts review of administrative claims, electronic medical records, survey and clinical data
• Develops and implements prediction models for member and provider-based interventions
• Researches and analyzes broadly defined business scenarios, trends, and patterns
• Provides technical/analytical advice to staff
• Compiles results of studies for journal publication