Elevance Health

Manager

• 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
• Conducting assessments to identify individual needs and a 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
• Interfacing with Medical Directors and Physician Advisors for treatment plans
• Assisting in problem solving with providers, claims or service issues

Nurse Case Manager I – NICU

Administration

• Assists with the development and implementation of procedures from the customer service aspect for all clients (internal and external)
• Assists in the strategy and implementation of new products and services from the production operations perspective
• Assists in the management of a high-volume shared mailbox by monitoring incoming messages, triaging, and prioritizing requests, assigning/forwarding items as needed, and ensuring timely, accurate responses
• Track inquiries from intake through resolution, perform research to identify answers, and coordinate with internal teams to close out open items
• Validate client reports for accuracy, completeness, and consistency prior to delivery
• Track expected vs. received files and promptly identify missing, late, or failed transmissions
• Review, validate, and implement client exclusion and special handling changes; confirm updates are reflected across all required platforms/tools
• Assist with loading recovery files and researches and resolves any file load exceptions by analyzing source data and matching records to the correct member/group eligibility combinations
• Perform regression testing following system releases to validate existing functionality and identify unintended impacts
• Implement letter template changes (content, variables, formatting) and validate outputs through testing/quality checks prior to use
• Other ad hoc projects/tasks as needed

Program Administrator – Carelon Payment Integrity

Learning and Development

• Facilitates learning events that are performance-based in nature.
• Delivers synchronous and asynchronous learning events using varied media in virtual and in-person environments.
• Employs rapid course development methodologies to quickly meet market needs.
• Exercises management of the learning environment including learner performance and escalates issues to leadership.
• Measures, tracks and evaluates learner and market satisfaction.
• Thinks and acts globally and is aware of adult learning and cultural differences that drive learner effectiveness.
• Keeps technical skills updated.
• Travels to worksite and other locations as necessary.

Training Specialist – LTSS Service Coordination

Account Manager

• Serves as primary Pharmacy Business Driver leading Account Management
• Communicates the Company value proposition to clients and prospects and meeting revenue goals, profitability, satisfaction, and retention parameters as per the Key Performance Indicator (KPI) structure
• Delivers client retention and satisfaction strategies that drive results, execution excellence
• Involves significant engagement with matrixed resources that support accounts, resulting in client satisfaction and retention
• Works with internal partners to develop client strategies that drive growth, retention, ongoing profitability, and operational excellence
• In collaboration with VP & Chief Sales Officer CarelonRx, helps align pharmacy services team efforts with business objectives
• Interacts with Anthem leadership, including regional leaders, plan presidents, and other key stakeholders responsible for customer experience
• Builds solid internal cross-functional relationships at all levels of Client Management, Finance, Operations, and IT
• Involves launching, expanding, and enhancing the CarelonRx pharmacy growth and retention model in collaboration with Anthem leadership and market regional sales/account management leaders
• Works with market account management leaders to develop and implement client-specific retention strategies and broader solution upselling strategies to meet business objectives
• Hires, trains, coaches, counsels, evaluates performance of direct reports

RVP, CarelonRx Account Management – West Region

Artificial Intelligence

• Determines how decision support systems and AI-enabled solutions will provide the data required to make effective business decisions.
• Performs modeling of information sources, dataflows, and analytical pipelines.
• May coordinate the activities of a project team and monitor project schedules and costs for own projects.
• Create and maintain reporting and advanced analytical solutions leveraging enterprise data platforms.
• Ensure data quality, integrity, and alignment with enterprise data architecture.
• Develops and supports complex data warehouse-related and analytical applications, including scalable data pipelines and model ready datasets.
• The majority of time will be spent hands on coding, data analysis, and building reusable analytical/AI components.
• Provide training and guidance on analytics tools, models, and data products.

Advanced Analytics & AI Consultant

Cloud Engineer

• Define enterprise AI/ML architecture strategy across multiple cloud providers (AWS, Azure, GCP)
• Author and evangelize whitepapers/position papers defining principals and strategies for AI/ML cloud platforms
• Liaison with Enterprise Architecture, Enterprise Data and Analytics, and Information Security teams to design and enhance end-to-end ML pipelines including data ingestion, feature engineering, training, deployment, and monitoring
• Establish ML Ops standards for cloud (CI/CD for ML, model registry, feature store, monitoring) and cloud control frameworks to support these
• Drive adoption of responsible AI, model governance, and risk management frameworks
• Partner with data science teams to operationalize models at scale
• Serve as a technical ‘Sherpa’ for Elevance projects leveraging AI/ML in any public cloud provider
• Evaluate and implement ML platforms (SageMaker, Vertex AI, Azure ML, Databricks ML, etc)
• Enable real-time and batch inference architectures
• Establishes overall systems architecture vision and ensures specific components are appropriately designed and leveraged; contributes to the holistic vision of Enterprise Architecture
• Maintains components of architecture strategy and vision
• Maintains enterprise level blueprints
• 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 is responsible for enterprise level technology and architectural standards, guidelines, principles, frameworks, and reference models

Principal Cloud Engineer – AI/ML

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 documents information, activities and changes in the database
• Develops and maintains positive customer relations
• Researches and analyzes data to address operational challenges and customer service issues

Customer Care Representative I

Bilingual

• Provides urgent health care via telephone and tele video modalities to patients who receive home and community-based services through state Medicaid programs, dual eligible members and other membership as assigned by our MCO partners
• Develops and implements clinical plans of care for adult patients facing chronic and complex conditions (e.g., co-morbid medical and mental health diagnoses, limited personal resources, chronic medical conditions.)
• Gathers history and physical exam and diagnostics as needed, and then develops and implements treatment plans given the patient’s goals of care and current conditions
• Identifies and closes gaps in care
• Meets the patient’s and family’s physical and psychosocial needs with support and input from the company’s inter-disciplinary team
• Educates patients and families about medication usage, side effects, illness progression, diet and nutrition, medical adherence and crisis anticipation and prevention
• Maintains contact with other clinical team members and other medical providers to coordinate optimal care and resources for the patient and his or her family in a timely basis and consistent with state regulations and company health standards and policy
• Maintains patient medical records and medical documentation consistent with state regulations and company standards and policy
• Participates in continuing education as required by state and certifying body
• Prescribes medication as permitted by state prescribing authority

Bilingual Nurse Practitioner

Systems Engineer

• Defines functionality, usability, reliability, performance and support requirements of a system.
• Creates and performs feature testing and determines environmental needs.
• Provides the link between the technical and business views of the system.
• Partners with business, architecture and infrastructure to ensure business area satisfaction.
• Mentors and assists in training initiatives.
• Proactively works with stakeholders to identify future system opportunities and enhancements.
• Develops use cases.

Systems Analyst Advisor – Encounters Implementation Support

• 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