Elevance Health

Manager

• Collaborate effectively with enterprise strategy team members and leadership in the development and execution of strategy projects
• Identify, prioritize and select strategic initiatives
• May be responsible for managing mid-level projects that cross multiple business units
• Problem-solving difficult challenges with known and unknown solutions
• Performs advanced analyses with short and long-term views
• Interprets research and intelligence to identify growth opportunities and provides recommendations to senior management
• Demonstrates thought leadership, team engagement, and an ability to execute on strategy
• Engagement/project oversight, establishing and reporting on key metrics and measurements
• Facilitates large cross-functional working sessions and meetings to align strategy and plan while providing Continuous Improvement coaching and mentoring to team members

Enterprise Strategy Consulting Manager

• 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
• Ensure member access to services appropriate to their health needs
• Conduct assessments to identify individual needs
• Facilitate authorizations/referrals as appropriate within benefits structure

Nurse Case Manager I

People Operations

• Establishes and enforces consistent frameworks, policies, and decision models that ensure compliant, defensible, and enterprise-aligned outcomes.
• Provides executive-level oversight and guidance on the most complex and high-risk employee relations and workforce cases.
• Identifies systemic trends and root causes to drive policy enhancements, process improvements, and preventative risk controls.
• Partners across HR, Legal, Compliance, and Centers of Excellence to align on risk thresholds, governance practices, and regulatory requirements.
• Designs scalable solutions that improve consistency, reduce escalations, and protect strategic HR capacity.
• Influences senior leaders on sensitive workforce decisions with significant organizational impact.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Director, People Resolution

• case management and collaboration with healthcare providers and members
• promote quality member outcomes and effective use of resources
• interpretation of moderately complex specialty drug prior authorization requests
• assess the medical necessity of outpatient specialty drug administration
• work with Pharmacists and Medical Directors

Nurse Case Manager I – Specialty Drug, Site of Care Review

Consultant

• Serve as key advisory to executive leadership on developing strategies to drive contractual and value-based success.
• Cultivate, maintain, and own strong, long-term relationships with executive leadership across population health, quality, finance, and clinical teams.
• Conduct detailed evaluations of provider protocols, processes, and staffing to determine their current capabilities in value-based care and identify key areas for growth and improvement.
• Design and lead strategic plans and initiatives rooted in operational realities to enhance provider performance by highlighting improvement opportunities with innovative value-based care solutions.
• Identify opportunities within the team as well as the broader market to drive greater efficiency and efficacy, fostering a culture of excellent, accountability, and continuous improvement.

Senior Provider Success Consultant – Value-Based Agreements

Medical Director

• 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
• Provides education regarding applicable clinical criteria
• Performs first level provider appeals for coverage decisions
• Provides support and education to internal clinical and non-clinical staff
• Participates in physician team meetings
• Participates in groups that develop, revise and enhance clinical appropriateness guidelines

Medical Director – Genetic Testing, Oncology

Growth Marketing

• Develops and implements client retention and account growth strategies
• Ensures client deliverables and contractual obligations are consistently met
• Provides strategic direction and coaching to Client Partnership Directors
• Partners with leadership to identify market trends and translates insights into actionable strategies
• Supports system implementations and migrations
• Leads, mentors, and develops a team fostering a high-performance culture
• Drives consistency in client management practices

Director – Client Management, Carelon Services

• Managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits
• Using appropriate screening criteria knowledge and clinical judgment to assess member needs
• Referring cases to Peer Reviewers as appropriate
• Assisting with more complex cases and may participate in inter and intradepartmental teams projects and initiatives

Behavioral Health Care Manager II

General Counsel

• Primarily responsible for managing defensive, and where appropriate, affirmative litigation for health plans
• Includes internal fact investigation, strategic decision-making and partnering with business and outside counsel
• Providing risk assessment and guidance to various business areas on a wide variety of issues
• Providing litigation support to our behavioral health, PBM, specialty pharmacies, benefits management company and overpayment investigation and recovery areas
• Works as a strategic partner and decision maker with more senior leaders
• Manages work independently

Associate General Counsel – Litigation

Risk

• Set and execute the enterprise strategy for commercial risk adjustment
• Own program performance, operating model design, regulatory and audit readiness
• Partner closely with enterprise functions and leaders to deliver measurable improvements
• Define and lead the multi-year commercial risk adjustment strategy, roadmap, and annual operating plan
• Establish a scalable operating model with clear accountability and performance management
• Build, mentor, and lead high-performing teams across risk adjustment operations
• Serve as the executive point of accountability for commercial risk adjustment performance
• Own end-to-end performance across risk capture, coding accuracy, documentation improvement
• Lead provider-facing risk adjustment enablement strategy including education and workflow integration
• Sponsor analytics and technology capabilities to support risk adjustment
• Ensure compliant, ethical risk adjustment practices

Staff VP, Commercial Risk Adjustment

• Develops, implements and controls the credentialing process for all in-house professional provider consultants and all contracted providers within the region
• Provides guidance regarding policies, procedures and regulatory requirements
• Ensures that all legal, licensure and accreditation standards are met
• Reviews the approval and termination of professional provider contracts as they relate to the credentialing process
• Ensures the accurate and timely information for the purposes of re-credentialing, data analysis and directory generation as well as recommending changes to the credentialing criteria and processes
• Monitors all governmental and private agency initiatives in the credentialing area
• Ensures all credentialing and re-credentialing policies and processes are in compliance with NCQA and all applicable state regulations
• Assures credentialing activities are integrated within the appropriate QI committees and departments
• Hires, trains, coaches, counsels and evaluates performance of direct reports

Manager II, Credentialing – BioPlus Specialty Pharmacy

Solutions Engineer

• Maintain active relationships with business stakeholders to understand needs, gather requirements, and review solution designs
• Facilitate large group JAD sessions as needed
• Submit initiative intake requests and owns review of Level of Effort (LOE) estimates
• Engage Enterprise IT teams to validate feasibility, standards, and dependencies
• Define application scope and objectives
• Supervise preparation of functional and/or technical specifications
• Maintain technical decision logs and ensure traceability from requirements through design, build, testing, and release artifacts
• Own the change request process, coordinate cross-team delivery, and develop/maintain the prioritized list of approved enhancements
• Lead delivery of application enhancements and projects
• Perform/coordinate technical design reviews and code reviews
• Ensure appropriate testing is completed (unit, system/integration, regression, performance as applicable) and the solution is implemented according to plan
• Validate non-functional requirements (performance, scalability, security, monitoring, supportability) are defined and addressed prior to implementation
• Drive train-level and team/Scrum-level risk and dependency management; escalate issues and propose mitigation options
• Coordinate technical readiness and obtain required release approvals
• Coordinate and manage production support
• Own the system monitoring process
• Lead root cause analysis and corrective/preventive actions
• Monitor the spend against the budget for the portfolio/initiatives and flag variances and risks early
• Lead vendor evaluation and analysis
• Manage vendor delivery performance as applicable
• Contribute to application technology solution delivery and data/information planning efforts

Senior Solutions Engineer

Financial Planning and Analysis

• Reviews and validates paid claims for overpayments using various techniques
• Determines and calculates amount of overpayments and processes refunds
• Researches voluntary refunds for accuracy
• Requires accurate balancing of all accounts
• Responsible for more routine issues
• May work with internal staff from other departments to ensure customer satisfaction
• May perform collection activities to ensure the recovery of overpayments

Financial Operations Recovery Specialist I

• Responsible for performing case management telephonically and/or by home visits for behavioral health and substance abuse needs
• Uses appropriate screening criteria and clinical judgment to assess member needs
• Conducts assessments to identify individual needs and develops care plans
• Monitors and evaluates effectiveness of care plans and modifies as needed
• Coordinates with internal and external resources to meet identified needs of the members and collaborates with providers

Behavioral Health Case Manager I – Pediatric and Adult Care Coordination

• Conducts assessments to identify individual needs
• Develops comprehensive care plan to address objectives and goals as identified during assessment
• Supports member access to appropriate quality and cost-effective care and modifies plan(s) as needed
• Coordinates with internal and external resources to meet identified needs of the member in terms of integrated (physical and behavioral) whole person care
• Coordinates social determinants of health to meet the needs of the member and incorporates that into care planning
• Works closely with various state agencies
• Maintains knowledge of the system of care philosophy; a spectrum of effective, community-based services and supports for those with or at risk for mental health or other challenges and their families, that is organized into a coordinated network
• Builds meaningful partnerships with designated populations and their families, and addresses cultural and linguistic needs, in order to help them function better at home, in the community, and throughout life
• Evaluates health needs and identifies applicable services and resources in conjunction with members and their families
• Provides important information including patient education, medication reconciliation, and identification of community resources and assists with arrangement of follow-up care