Elevance Health

Business Analyst

• Analyzes business needs to determine optimal means of meeting those needs
• Determines specific business application software requirements
• Works with programming staff to ensure requirements will be incorporated into system design and testing
• Acts as liaison with users of the software to address questions/issues

Business Analyst II – 837 Encounters

Program Manager

• Leads pharmacy programs to improve Stars performance and lower cost of care in value-based organizations
• Manages both internal and external stakeholders
• Resolve pharmacy benefit issues
• Support Sales and provider-facing pharmacists with clinical guidance, standardized workflows, and cross-functional alignment to ensure compliance
• Ensures the proper reaction to and resolution of issues concerning the pharmacy benefit program
• Acts as a support resource for the sales team regarding efforts to improve the performance of the pharmacy benefit for existing accounts
• Lead analytics-driven pharmacy programs to improve Medicare Stars medication measures, close quality gaps, and reduce avoidable cost of care

Pharmacist Program Manager

• Analyzes complex end user needs to determine optimal means of meeting those needs
• Determines specific business application software requirements to address complex business needs
• Develops project plans and identifies and coordinates resources, involving those outside the unit
• Works with programming staff to ensure requirements will be incorporated into system design and testing
• Acts as a resource to users of the software to address questions/issues
• May provide direction and guidance to team members and serves as an expert for the team

Business Analyst III – Implementations

Business Intelligence Analyst

• timely and accurate preparation of complex external financial statements
• coordinates and compiles complex financial statements and analyzes results
• assist in the interpretation of new accounting pronouncements
• prepares draft responses to government and/or regulatory agencies requests
• provides information for external audits
• interfaces with departments and management to communicate concerns and resolve issues timely
• may prepare draft technical accounting position memorandums
• coordinates and compiles annual and semi-annual Risk-Based Capital calculations

Financial Reporting Analyst

Director

• leads and manages multiple cost of care initiatives including the most complex initiatives enterprise wide
• understands, predicts and implements measures to control healthcare costs and to make healthcare more affordable for our customers
• develops, manages, oversees, and executes new and innovative initiatives to manage rising costs and enhance the company's market competitiveness
• identifies and develops best practices and cost of care improvement processes
• oversees the identification of potential cost of care savings opportunities through complex analytics
• champions cost of care initiatives, negotiates for human capital resources, and partners with care management, claims, IT, and business partners
• manages and presents cost of care projects to senior leadership
• serves on local and enterprise committees

Cost of Care Director

Analyst

• Ensures accurate adjudication of claims
• Translating medical policies into reimbursement rules
• Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code
• Conduct clinical research, data analysis, and identification of legislative mandates
• Perform pre-adjudication claims reviews
• Prepares correspondence to providers regarding coding and fee schedule updates
• Trains customer service staff on system issues

Medical Coding Appeals Analyst

• Manages and coordinates the development, approval, implementation and compliance of on-going external client facing programs
• develops program budget
• ensures program meets its stated objectives
• provides subject matter expertise in response to day to day external client facing business issues
• Researches applicable subject matter practices and remains aware of industry trends
• Manages external client facing relationships and partners with corporate and regional business areas
• Coordinates training related to external client facing program
• develops program success measures and performs periodic assessments of program success
• Design, implement, and manage enterprise-wide associate safety programs, policies, and standards
• Identify emerging safety risks, including workplace violence, environmental hazards, and operational safety concerns
• Partner with cross-functional teams to develop mitigation strategies and response protocols
• Oversee tracking, reporting, and analysis of safety incidents and near misses
• Develop and deliver safety training programs for associates and leaders
• Establish and monitor key safety metrics (e.g., incident rates, response times, training completion)
• Analyze trends and provide actionable insights to leadership
• Ensure alignment with regulatory requirements, corporate policies, and industry best practices
• Support audits, assessments, and remediation efforts
• Partner with Security, HR, Legal, Risk, and Operations to align safety initiatives
• Act as a liaison between corporate teams and site-level leadership

Sales

• telephonically selling Small group products
• providing high level customer service
• ensuring sales goals are met
• selling company products in a professional and consultative manner
• providing thorough and effective customer service
• maintaining comprehensive working knowledge of all company products and services
• optimizing closing opportunities
• maintaining records and updating database documentation of all activities during the sales cycle

Direct Small Group Sales Agent

Bilingual

• Participating in delivery of patient education and disease management interventions
• Performing health coaching for members
• Conducting behavioral or clinical assessments to identify individual member knowledge, skills and behavioral needs
• Identifying and/or coordinating specific health coaching plan needs
• Interfaces with provider and other health professionals for health coaching plan coordination
• Implementing and/or coordinating coaching and/or care plans
• Using motivational interviewing to facilitate health behavior change
• Monitoring and evaluating effectiveness of interventions

Transitions of Care RN – Bilingual Preferred

• Provides urgent health care via telephone and tele video modalities to patients
• Develops and implements clinical plans of care for adult patients facing chronic and complex conditions
• Gathers history and physical exam and diagnostics as needed, and then develops and implements treatment plans
• Identifies and closes gaps in care
• 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
• Maintains patient medical records and medical documentation consistent with state regulations and company standards
• Participates in continuing education as required by state and certifying body
• Prescribes medication as permitted by state prescribing authority

Nurse Practitioner, Bilingual, 100% Virtual

Medical Director

• responsible for the appeal reviews for physical health medical services
• ensure appropriate and most cost-effective medical care is received
• develop and implement programs to improve quality, cost, and outcomes
• provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations
• identify cost of care opportunities

Medical Director – Oncology

• Drives profitability at the district and infusion centers level by effectively leading frontline associates
• Manages sales activities to produce desired sales results established leadership
• Manages the profitability within the budget of their district by maximizing profitable revenue, staffing levels and sales expenses while maximizing patient growth
• Works closely with the Center Operations Managers (COMs) and regional leadership to ensure the highest quality of support for patients
• Monitors progress in meeting established objectives
• Ensures optimum coverage for all customers and potential customers
• Completes customer contact and market reports and informs leadership on market changes
• Forecasts sales performance
• Ensures effective distribution of products in the district including adequate stocking and adequate coverage of all distribution channels
• Travels extensively
• Hires, trains, coaches, counsels, and evaluates performance of direct reports