Elevance Health

Medical Director

• Ensures timely completion of clinical case reviews for their board certified specialty
• Makes physician to physician calls to gather appropriate medical information for medical necessity determinations
• Makes medical necessity determinations for grievance and appeals appropriate for their specialty
• Ensures consistent use of medical policies when making medical necessity decisions
• Brings to their supervisors attention, any case review decisions that require Medical Director review

Associate Medical Director – Interventional Pain

Director

• Collaborate with business stakeholders and product/digital teams to gather and document requirements for IT projects
• Maintain open communication between IT teams and business units
• Facilitate solution development by translating business needs into technical specifications
• Identify potential issues, project changes, and scope data
• Conduct cost/benefit analyses and build support for business change throughout the business unit
• Provide process, project, and change management methodology coaching

Business Change Director – SIU Fraud and Abuse

AI Engineer

• Analyze and model organizational data for AI function to draw business insights
• Apply data extraction, transformation and loading techniques for large data sets
• Develop LLM strategies and enhance AI ML model deployment efficiency
• Design and develop custom ML, Gen AI, NLP, LLM Models for AI ML pipelines
• Work closely with MLOps team to create and maintain evaluation solutions for models
• Collaborate with product teams and stakeholders for deployment in production environments
• Ensure adherence to standards, governance, and best practices in ML model development

Gen AI Engineer

Manager

• perform 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
• performing duties telephonically or on-site such as at hospitals for discharge planning
• ensure members understand benefits and assist in access of services appropriate to their health needs
• conduct assessments to identify individual needs and a specific care management plan
• implement care plan through actions based on assessments
• coordinate internal and external resources to meet identified needs
• monitor and evaluate effectiveness of the care management plan and modify as necessary
• interface with Medical Directors and other health professionals on the development of care management treatment plans
• assist in problem solving for members and providers related to access to care, vendors, claims or service issues

Telephonic RN Nurse Case Manager I

Content Marketing Manager

• Driving the development and execution of the clinical content scope in alignment with the product and content strategy to meet financial and operational targets
• Researching and interpreting CMS, CPT/AMA and other major payer policies based on medical coding and regulatory requirements
• Identifying common error areas that can be made into automated software logic to prevent overpayments from occurring
• Taking edits from concept to specification and then through review, testing and finally data validation
• Developing claims editing logic and content that promote payment accuracy and transparency
• Leading fee schedule development for specific plan(s) and/or the development and implementation of clinical editing rules
• Working with business partners to assist with cost of care claim editing goals
• Performing and/or directing complex fee modeling exercises to ensure that projected unit reimbursement changes meet corporate cost targets
• Reviewing healthcare policy (Medicaid manuals, fee schedules, CCI, OIG Alerts, LCAs/LCDs, NCDs, Medicare manuals, etc.) for coding and billing guidelines that can be turned into software editing rules
• Creating billing edits that provide clients with monetary savings and promote coding accuracy
• Preparing and presenting cost of care data analysis to support the regions cost of care initiatives
• Developing and maintaining the provider reimbursement strategy that will lower the cost of care, improve service, and reduce administrative expenses
• Managing special projects and initiatives

Manager, Clinical Content – Reimbursement

Analyst

• Develops statistical subject matter expertise of the research data and integrated environment, and data products.
• Leads and supports statistical analyses using research methods in emerging real-world data sources and clinical research.
• Assists in reviewing and advising on data management activities.
• Supports development of statistical content for study documentation and client-facing deliverables.
• Performs analytic methodology execution, including writing programming specifications and developing programs for statistical analysis.
• Contributes ideas for new analyses, data products, and research projects, and provides analytic insight to support product development efforts.
• Articulates methods, process, progress and results to internal and external stakeholders.
• Collaborates with the Scientific and Project Management teams to ensure adherence to scope, schedule, and quality expectations.

Data Products Analyst

• Lead the growth and performance of Advanced Home Delivery (AHD)
• Coordinate cross-functional partnerships and drive strategic initiatives
• Monitor regulatory and legislative developments for compliance
• Identify and evaluate new business opportunities and revenue expansion strategies
• Support the development of strategic and annual operating plans
• Travel to worksite and other locations as necessary (10%-15% Travel)

Strategy & Program Development Director – Advanced Home Delivery

Actuary

• Analyzes and implements risk contracts including conducting experience analyses, pricing, filing and settlement work
• prepares management reports supporting new capitation initiatives
• Assists in training of actuarial trainees, analysts and specialists
• Coordinates/directs special actuarial projects

Actuarial Analyst III

• Completes projects and performs complex actuarial studies
• Obtains, verifies, analyzes and models data including risk reporting and forecasting
• Calculates monthly claims liability reserves
• Develops merit rating factors
• Prepares Department of Insurance annual statement exhibits

Actuarial Analyst II

Artificial Intelligence

• Lead the design and execution of Compliance Monitoring and Oversight activities, including reviews, audits, and control assessments.
• Establish risk-based monitoring plans aligned to regulatory requirements and AI governance priorities.
• Oversee end-to-end engagement lifecycle: planning, testing, issue identification, and remediation tracking.
• Implement automated monitoring capabilities to enhance efficiency, scalability, and real-time risk detection.
• Leverage digital technologies and AI to enhance monitoring effectiveness and drive continuous program improvements.
• Synthesize findings into clear reporting, metrics, and actionable insights for stakeholders and leadership.
• Drive continuous improvement of monitoring methodologies, tools, and documentation standards.
• Provide advisory guidance on control effectiveness, regulatory alignment, and risk mitigation strategies.
• Facilitate stakeholder engagement, including interviews, issue resolution, and escalation management.
• Develop and maintain frameworks, job aids, and training to support consistent oversight execution.

AI Compliance Monitoring, Audit Advisor

Backend Engineer

• Design and implement scalable, high-performance backend architectures across distributed, cloud-native systems
• Define and contribute to system architecture, integration patterns, and API design standards
• Collaborate on architecture decisions across cloud and multi-platform environments
• Develop and maintain backend services using Java/Spring Boot, Kotlin, PostgreSQL, AWS, and Docker
• Ensure system reliability, scalability, performance, and observability in production environments
• Support CI/CD pipelines, deployment automation, and cloud infrastructure design
• Mentor engineers and promote best practices in backend development and system design
• Collaborate with stakeholders to align technical solutions with business needs and platform goals
• Research and recommend new technologies and enhancements to improve platform capabilities

Senior Backend Architect – Device Management Platforms

• Executes centralized intake and risk-based prioritization of regulatory inquiries
• Advises stakeholders on the applicability of technology regulatory requirements (e.g., AI governance, data privacy, model risk, cybersecurity)
• Designs, implements, and enhances Technology Governance processes for AI
• Establishes and operates Compliance Monitoring and Oversight programs
• Conducts risk-based reviews and audits of AI-enabled and technology-driven processes
• Evaluates the design and operating effectiveness of controls across technology, AI, and data environments
• Researches emerging regulatory expectations and industry practices related to AI and technology compliance
• Assesses risk across IT systems, AI use cases, and supporting operational processes
• Develops governance artifacts, including Client Assistance Guides (CAGs), standards, procedures, and training materials
• Produces clear reporting, metrics, and executive-level summaries on compliance posture, risks, and issues
• Partners with internal and external auditors; responds to audit requests and supports regulatory inquiries

Senior Advisor, AI Governance – Technology Compliance

• Lead identification, development, and execution of Cost of Care strategic initiatives with executives and business unit senior management.
• Report project status to senior leadership.
• Partner with market and enterprise leadership by providing ongoing feedback on program performance, identifying drivers of success, and delivering insights into future opportunities for program enhancements or expansion.
• Support day-to-day activities for a team of advanced analysts, delivering reporting and data analytics to achieve strategic objectives.
• Develop and sustain a high-performing team through training and effective organizational development practices; responsible for hiring, coaching, counseling, and evaluating the performance of direct reports.
• Implement the policies, practices, and procedures of the company and business units supported.
• Expand and strengthen relationships with stakeholders both internal and external.

Director of Cost of Care

• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients’ office visits with providers and external physicians.
• Applies clinical knowledge and skills to utilization review processes.
• Adheres to medical policies and clinical guidelines.
• As assigned, engage in clinical and non-clinical activities that impact health care quality cost and outcomes
• If requested, provides guidance for clinical operational aspects of a program.
• May be required to serve on internal and/or external committees.
• May develop and propose new medical policies based on changes in healthcare.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.

Behavioral Health Medical Director – Child Psychiatrist

Cloud Engineer

• Design and build secure, scalable, and resilient cloud architectures across AWS, Azure, and/or GCP.
• Implement and maintain infrastructure-as-code (Hashi, PHP, Python, MCPs) with embedded security controls.
• Build automated compliance solutions aligned to HIPAA, HITRUST, NIST, and ISO frameworks.
• Build and enforce secure patterns for IAM (PIM/PAM), encryption, secrets management, and network security w/zero trust.
• Develop and integrate DevSecOps pipelines, including SAST, DAST, and policy-as-code enforcement.
• Conduct hands-on vulnerability remediation and security hardening supporting cloud workloads.
• Build and enhance cloud-native platforms (containers, Kubernetes, service mesh) with integrated security controls.
• Write and maintain automation and platform code to improve scalability, reliability, and security posture.
• Lead debugging and resolution of complex cloud and security issues in production environments.
• Serve as a technical leader and mentor, providing code reviews, design guidance, and hands-on support for security related needs.
• Maintains active relationships with customers to determine business requirements, leads requirements gathering meetings and reviews designs with the business.
• Anticipates broad technical change and ensures that company technology stays ahead of the curve.
• Prioritize projects and make trade-offs with respect to the enterprise systems changes based on broader business needs.
• Understands the entire architecture for a major part of our business and is able to articulate the scaling and reliability limits.
• Develops and defines application scope and objectives and supervises the preparation of technical and/or functional specifications from with programs will be written.
• Performs technical design reviews and code reviews.
• Ensures unit test is completed and meets the test plan requirements, system testing is completed and system is implemented according to plan.
• May participates in developing the multi-year technology strategy for critical areas of the business that may encompass multiple systems.
• Partners with technical and non technical stakeholder to identify the long term technical trajectory of the technology infrastructure.
• Creates architecture and anticipates future technology needs.
• Leads the conversations internally about the direction of major areas of the technology, drives wide-team consensus to the adoption of this direction, and uses this direction when engaging engineers.
• Reviews and monitors initiatives for end to end impact and coordination.
• Participates in review and decision making for enterprise solutions.