Elevance Health

Director

• Work with management to identify and implement varied projects, programs, and plans that support achievement of business unit and enterprise goals
• Specialize in one area of organization effectiveness (planning, project portfolio, or culture/change)
• Identify potential issues and scope data
• Lead efforts to identify best practices
• Develop and design processes and systems that support business needs
• Conduct cost/benefit analyses
• Build support for business change throughout the business unit
• Provide coaching/consulting support to both local and enterprise wide initiatives
• Lead project prioritization and scheduling activities for the business unit
• Support execution of the operating plan
• Develop new audit concepts
• Create/audit reports and paid claims to identify overpayment of claims
• Integrate information from various sources and consider broader context
• Identify and solve problems by identifying errors and overpayments within the Elevance enterprise
• Implement cross-audit concepts to Elevance functional areas and stakeholders

Business Change Director – Payment Integrity Ideation

Analyst

• Participate in on-site quality external audits such as NCQA, AAHC and EQRO
• Prepare audits of required documents
• Conduct contract-required quality record reviews
• Ensure providers’ compliance with policies, state and federal standards
• Conduct behavioral health audits of QM processes and files
• Analyze data and prepare quality management reports
• Define opportunities for improvement through trend analysis
• Assist in implementation and monitoring of quality studies
• Perform monthly, quarterly, annual and ad hoc medical record reviews
• Travel to worksite and other locations as necessary

Senior Behavioral Health Clinical Quality Audit Analyst

Project Manager

• managing multiple projects of varying sizes and duration
• bridging the gap between business need and technology design
• applying project management knowledge, skills, tools and techniques to project deliverables, processes, and systems
• coaching and mentoring project team members
• determining project scope and developing management plans
• tracking training plan milestones
• facilitating requirement gathering discussions
• developing project approval matrix
• identifying, tracking and ensuring completion of project team training and tool needs
• coordinating requirements gathering, schedules implementation and post-implement plans
• defining quality gates for each project methodology phase
• establishing and managing the project warranty period

Senior Project Manager – Regulatory

Financial Planning and Analysis

• Receives, validates and enters information into Finance systems
• Adheres to maintained internal controls and tracking reports for reconciliations and analysis
• Monitors and updates controls to ensure compliance
• Conducts independent analysis for the purpose of resolving complex and varied work process issues
• Accurately process deposits for COBRA checks and provider refunds
• Address customer service call logs concerning check tracers
• Run financial reports and analyze data to support business operations
• Assist with various financial operations tasks and projects as needed
• Work closely with team members and other departments to resolve issues

Financial Accounting Operations Specialist

Manager

• 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
• Performing duties telephonically or on-site for discharge planning
• Ensuring member access to services appropriate to their health needs
• Conducting assessments to identify individual needs and specific care management plan
• Implementing care plan by facilitating authorizations/referrals as appropriate
• Coordinating internal and external resources to meet identified needs
• Monitoring and evaluating effectiveness of the care management plan
• Modifying care plans as necessary
• Interface with Medical Directors and Physician Advisors on care management treatment plans
• Assisting in problem solving with providers, claims, or service issues

Pediatric Nurse Case Manager I

• 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
• 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
• assists in problem solving with providers, claims or service issues.

Nurse Case Manager, HMO

Customer Success Manager

• Managing client relationships and ensuring satisfaction with CareBridge’s services
• Facilitating communication between clients and internal teams for program services implementation
• Partnering with cross-functional operations and finance teams to forecast and track key operational and financial metrics
• Developing and maintaining relationships with leadership at managed care organizations

Account Services/Client Management Director

• Managing psychiatric and substance abuse treatment through telephonic or written review
• Assessing member needs to ensure access to medically necessary behavioral healthcare
• Referring cases to Peer Reviewers as appropriate
• Coordinating assessments, implementing case planning, monitoring and evaluating for quality member outcomes

Behavioral Health Care Manager I – 3rd Shift

• develops and implements strategies as set by senior management across the enterprise
• serves as primary management point of contact for global issues related to enterprise business continuity and Elevance Health’s third-party suppliers’ business continuity
• serves as resource and subject matter expert for issues relating to continuity of business operations
• leads strategic planning with business units in developing response and recovery plans, as needed
• manages implementation and revision of enterprise external release business continuity plans
• conducts audits and integrated tests of Elevance Health’s enterprise and third-party supplier plans
• works collaboratively with internal shared services departments in integrating enterprise and third-party suppliers plans to support business continuity

Global Business Resilience – Continuity and Resilience Manager

Customer Support

• Responds to internal and external customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.
• Analyzes problems and provides information/solutions.
• Operates a PC/image station to obtain and extract information and thoroughly documents inquiry outcomes.

Customer Care Representative I

• performing case management telephonically and/or by home visits within the scope of licensure for members with behavioral and mental health needs
• uses appropriate screening criteria knowledge and clinical judgment to assess member needs
• conducts assessments to identify individual needs and develops care plan to address objectives and goals as identified during assessment
• monitors and evaluates effectiveness of care plan and modifies plan as needed
• supports member access to appropriate quality and cost effective care
• coordinates with internal and external resources to meet identified needs of the members and collaborates with providers.

Behavioral Health Case Manager I

• Provide case management services to individuals with serious mental illness (SMI)
• Conduct regular outreach to assigned members to build rapport and assess needs
• Link members to needed services/resources and provide short-term support (up to 6 months)
• Respond to complex cases and account specific requests
• Conduct assessments to identify individual needs and develop care plans
• Monitor and evaluate effectiveness of care plans and modify as needed
• Coordinate with internal and external resources to meet identified needs

Behavioral Case Manager II

• Working with the team and cross functional stakeholders at all levels across the enterprise to identify and implement multi-faceted, complex projects, programs and plans focused on the affordability of healthcare while simplifying the member and provider experience
• Driving member centric narratives that ensure activities are aligned with corporate strategy and member value working directly with the Healthcare Affordability team
• Identifying potential issues, project change, and scope data
• Leading efforts to identify best practices
• Leading end to end execution risk pathways between ideation and execution of enterprise initiatives
• Developing executive summary documents
• Identifying impacted parties, business partners, and resources required
• Developing and designing processes and systems that support business needs
• Designing methods for integrating functions and processes
• Conducting cost/benefit analysis
• Building support for business change throughout the business unit
• Providing process, project, and change management methodology coaching/consulting support to both local and enterprise wide initiatives
• Leading the project prioritization and scheduling activities for the business unit
• Providing expertise in process planning and portfolio management activities

Business Change Director

• 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