Elevance Health

Account Executive

• Responsible for the growth and retention of existing accounts to include upsells to a higher level of products/services within the large group segment.
• Achieves retention and growth targets through expert execution of sales process.
• Cultivates deep trust-based relationships and develops comprehensive understanding of client needs and priorities.
• Acts as a consultative collaborative partner with brokers, consultants, and key decision makers.
• Develops strategic business plans to address broker and/or client needs.
• Coordinates with internal partners to meet and exceed client expectations.
• Drives opportunities for additional growth and product sales.
• Provides expert consultative and strategic sales knowledge to Large Group and/or Complex jumbo groups.

Strategic Account Executive

General Counsel

• provide legal advice on enterprise-wide technology and international operations matters
• advise on development, use and sale of digital health technology products
• collaborate across the enterprise to provide legal support
• assess legal risk and propose risk mitigation options
• partner with Public Affairs and Compliance teams to identify evolving regulations
• provide ongoing internal education and training on legal issues

Associate General Counsel Sr. – Technology, International Operations

• Establishes and expands strategic relationships with C-suite and executive leadership across national and regional Managed Care Organizations
• Understands all aspects of the business and partners with executive leadership to define strategy and successful criteria for the future
• Establishes, builds, and nurtures executive level relationships at targeted accounts
• Articulates and introduces CareBridge and Carelon at Home specific solutions to new customers
• Establishes and maintains a high level of visibility within industry groups and ecosystem
• Collaborates with and influences product development strategies
• Identifies, pursues, and closes net new opportunities and accounts
• Develops strategies and executes sales plans to achieve membership growth and financial goals
• Supports account finalist opportunities for new sales and account management
• Proposes opportunities to improve results based on continuous needs assessment
• Collaborates with Product /Solution teams to inform the development of offerings

Sales Executive – Managed Care

Manager

• Oversees and manages Clinical Programs operations
• Manages patient caseloads
• Provides resources and direction to Nurse Practitioners
• Performs physical examinations, preventive health measures, and follow up visits within prescribed guidelines and physician instructions
• Orders, interprets and evaluates diagnostic tests to identify and assess patient's clinical problems and health care needs
• Discusses case with physician and formulates and documents care plan
• Prescribes medication or other forms of treatment
• Reviews documentation to ensure compliance with best practices, protocols, and quality measures
• Hires, trains, coaches, counsels, and evaluates performance of direct reports

Manager, Nurse Practitioners

Medical Director

• Supports clinicians to ensure timely and consistent responses to members and providers
• Provides guidance for clinical operational aspects of a program
• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
• Serves as a resource and consultant to other areas of the company
• Interprets medical policies and clinical guidelines
• Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes
• Identifies and develops opportunities for innovation to increase effectiveness and quality

Medical Director – Psychiatrist, Child Adolescence

Data Engineer

• 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) and provides notations of performance deviations and anomalies
• Serves as a subject matter expert in data analysis and reporting, formulating actionable recommendations and providing guidance to other data analysts
• Creates and publishes periodic reports, as well as develops ad hoc reports to address emerging business questions and priorities
• Translates complex business issues into diagnostic and/or tracking data solutions that convert business requirements into actionable decision support tools
• Identifies trends, patterns, and outliers in large and complex datasets to inform strategic and operational decisions
• Provides analytic consultation to business partners, leadership, and external customers to support performance improvement initiatives
• Makes data-driven recommendations based on analysis and clearly communicates findings to technical and non-technical stakeholders
• Ensures data integrity, consistency, and accuracy across reporting solutions and analytic outputs
• Supports a higher level of complexity in data analysis and reporting, requiring advanced problem-solving, critical thinking, and independent judgment
• Ensures proper data definitions, ownership, use and integrity of data
• Analyzes more complex business user needs, documents information requirements, facilitates the identification of potential gaps in available data and collaborates with business areas to determine best means for acquiring the data needed
• Collaborates with IT resources on the creation and maintenance of the content of the data warehouse
• Establishes and maintains excellent knowledge of data warehouse data structure design, definitions, capabilities, programming languages, and data integrity issues
• Completes metadata assessment and reviews feedback to determine changes needed
• Ensures that data definitions are clear and current and communicates changes to data definitions to all users
• Collaborates with IT resources and data owners to define business objectives and definitions for databases including business rules, sources, purge archive criteria, and reload schedule.

Data Warehouse Consultant

Data Analyst

• Analyzes data and summarizes performance using summary statistical procedures.
• Creates and maintains databases to track business performance.
• Develops and analyzes reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
• Creates and publishes periodic reports, makes necessary recommendations, and develops ad hoc reports as needed.
• May require taking member data and devising best way to develop appropriate diagnostic and/or tracking data that will translate into usable decision support tools.

Population Health Data Analyst

• Perform case management telephonically and/or by home visits
• Use screening criteria knowledge and clinical judgment to assess member needs
• Conduct assessments to identify individual needs and develop care plan
• Monitor and evaluate effectiveness of care plan and modify as needed
• Support member access to appropriate quality and cost effective care
• Coordinate with internal and external resources to meet members' needs

Behavioral Health Case Manager I

• Provide legal advice and recommendations for initiatives and projects
• Negotiate and manage client contracts with health plan clients, state agencies, employer groups, etc.
• Collaborate with multiple business partners and legal colleagues
• Become the resident expert on contract management practices and software
• Ensure client contracts comply with applicable laws and appropriately allocate risk
• Provide effective legal guidance and risk assessments
• Assist business with pre-litigation contractual dispute management

Legal Counsel, Contracting

Clinical Operations

• Managing mail order operations including oversight of queue management, process development, dispensing accuracy and cross functional team collaboration.
• Developing and implementing clinical pharmacy programs to promote quality and cost-effective drug utilization.
• Assisting in the development of new clinical products.
• Managing clinical pharmacy operations and staff to ensure clients' objectives and deliverables are met.
• Overseeing departmental processes, policies and procedures, training, and communication.
• Ensuring achievement of department goals and objectives.
• Hiring, training, coaching, counseling, and evaluating performance of direct reports.

Manager, Pharmacy Clinical Operations – Advanced Home Delivery

Sales

• Develop and maintain relationships with external clients and prospects
• Execute strategic sales and tactical plans on Stop Loss Bundled products
• Provide ongoing support to regional leadership (state plan presidents)
• Interact directly with producer stop loss centers of excellence
• Assist in the development of strategic producer relationships
• Partner with leadership and develops key programs for growth and retention

Stop Loss Local Bundled Sales Manager

Security Engineer

• Provides first level engineering design functions and trouble resolution
• Leads or plans implementations for access management and network security technologies
• Develops testing plans to ensure quality of implementation
• Leads the investigation and reporting of data security events and incidents
• Provides system and network architecture support for information and network security technologies
• Provides technical support to business and technology associates in risk assessments and implementation of appropriate information security procedures
• Leads the development of strategies for discovery, evaluation and response to Mainframe Security threats
• Designs and engineers comprehensive access management and Mainframe security technical solutions based on business requirements and defined technology standards
• Works with architecture and IT to update technology direction and strategy
• Capable of serving as technical mainframe security lead for company, database and system merger and acquisitions
• Conducts and presents research on emerging Mainframe Security trends and best practices
• Establishes action plans, and advises on implementation of clean-up and security standards
• Provides security issue resolution and serves as point of technical escalation on complex problems when needed
• Creates presentations and seeks IT management approval and acceptance of significant replacements or reconfigurations of Mainframe security systems serving the Enterprise
• Works with leadership to set Mainframe Security vendor strategy and direction
• May be assigned to project teams for technical consultation to business partners and developers
• Designs and engineers comprehensive access management and Mainframe security technical solutions based on business requirements and defined technology standards
• Develops reports supporting strategy and direction for management
• Capable of serving as technical merger & acquisition lead.

Senior RACF Security Administrator

• Responsible for care management within the scope of licensure for members with complex and chronic care needs
• Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans
• Conducting assessments to identify individual needs
• Implementing care plan by facilitating authorizations/referrals
• Coordinating internal and external resources to meet identified needs
• Monitoring and evaluating effectiveness of the care management plan
• Assisting in problem solving with providers, claims or service issues

Nurse Case Manager

Consultant

• Supports Employee Assistance Program (EAP) service department by responding to initial customer contacts and request for services
• Receives client request, assesses situation, determines appropriate course of action
• Provides telephone and or on-site support for crisis intervention, assessment, short term problem resolution and referral to appropriate provider(s)
• Manages Critical Incident Stress Debriefing requests
• Assesses members and assists them in accessing behavioral healthcare benefits available under their health plan
• Manages shared mailbox that is used by clients and external vendor to forward information that must be reviewed and placed in documentation system

Behavioral Health EAP Consultant I

Product Manager

• Serves as the customer proxy and liaison between the business and the Scrum Teams
• Translating features into complex user stories within a team's backlog
• Managing, ranking and prioritizing the backlog to reflect stakeholder requirements
• Final testing and acceptance of the user stories supporting the features
• Effectively communicates stakeholder needs to the team
• Collaborate with team(s) to discover and deliver the best solution to the market problem(s)
• Work with the business to rank and prioritize business needs
• Manage the solution concept development process
• Create and maintain a regularly updated backlog of work through the project's life cycle
• Understand how to write user stories and acceptance criteria
• Serve as the Product Management proxy and decision point for stakeholders
• Reviews and accepts/rejects results during a Sprint and in the Sprint review
• Attends sprint meetings and is available for clarifications and acceptance of user stories
• Creates and/or inputs into a project's release plan