Elevance Health

Customer Support

• Completes administrative duties for efficient operations
• Notifies physician offices of the outcome of patient benefit investigations
• Triages prescriptions to in-network pharmacy
• Assists with prior authorization submissions and follows up with health plans
• Maintains client relationship management (CRM) and electronic medical records (EMR)

Sales Support Specialist

Manager

• Responsible for performing telephonic and face-to-face functional assessments for the identification, evaluation, coordination and management of member's needs
• Identifies members for high risk complications and coordinates care in conjunction with the member and the health care team
• Manages members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of health benefits
• Obtains a thorough and accurate member history to develop an individual care plan
• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs
• The RN has overall responsibility to develop the care plan for services for the member and ensures the member's access to those services
• May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible
• Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management of person-centered care plans
• May also assist in problem solving with providers, claims or service issues.

LTSS Service Coordinator – RN Clinician, RN Case Manager

Compliance

• Manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments
• audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness
• Establish project plans, gap analysis, milestone dates, and other significant aspects, and leadership updates
• Maintain knowledge of laws, regulations, company strategies to assess impact, and consult with clients as subject matter expert
• Conducts complex investigations, document findings, and ensure corrective actions are made
• Conduct complex regulatory requirement and guidance research and provide compliance and ethics related recommendations to operational leadership
• Interface with external clients, regulators, vendors, supplier; internal stakeholders, high level of management
• Ability to travel up to 10%

Compliance Manager – Infusion

Administrative Assistant

• Oversees staff and processes for check-in
• verifying charts are pulled for scheduled appointments
• demographics/eligibility is updated
• current forms are being utilized
• Listens and responds to patient and/or family members concerns
• Responds to patient questions and complaints
• routes issues to appropriate personnel
• Analyzes daily administrative operations and utilization of resources
• Assists in Medic user issues
• Ensures proper cash controls are in place and policy and procedures are followed

Administrative Assistant, PRN

Administration

• Responsible for overall management of member's individual service plan
• Develops, monitors, and revises the member's service plan
• Performs telephonic or face-to-face history and program needs assessments
• Identifies members with potential clinical health care needs
• Coordinates cases with clinical healthcare management and interdisciplinary team
• Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities
• Establishes short and long-term service goals in collaboration with the member, caregivers, family, etc.
• May serve as a mentor or preceptor for new staff

LTSS Administration Services Coordinator – Lead

Consultant

• Travels to client sites (day trips mainly during Q1 and Q2) as needed
• Drives strategic organizational impact by leveraging data and analytics to navigate complex business questions and develop actionable, evidence-based solutions
• Utilizes customer insights to craft strategic recommendations, supporting ongoing enhancement and effectiveness of solutions across diverse industry profiles
• Serves as a high-profile strategic consultant, influencing organization-wide decisions across product, network, and industry domains
• Translates data trends into strategic roadmaps, applying client feedback to fine-tune program development and execution
• Prioritizes and manages projects by negotiating and coordinating with internal and external stakeholders, enhancing project efficiency and information flow
• Conducts comprehensive data analysis and research to support business objectives, offering insights into areas like disease management and site of care navigation
• Evaluates and triages projects using cost-benefit analysis and urgency assessments to maximize value and impact
• Communicates strategic plans and action items for improvement drawn from data insights and business acumen
• Collaborates with business users to tailor information distribution, considering media, frequency, and target audiences for optimal communication
• Mentors and guide less experienced team members, identifying skills gaps and fostering professional development through targeted education initiatives
• Collaborates with the data warehouse analysts in establishing business rules and monitoring adherence
• Tracks and prioritizes projects through coordination and negotiation with internal and external clients to improve the efficiency of information/project plan generation
• Performs strategic data analysis (data mining) and research as appropriate to support business needs (e.g., disease management, provider profiling, etc.)
• Develops detailed understanding of relevant business processes, goals and strategy in order to provide analysis and interpretation

Senior Health Information Consultant

Business Analyst

• 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
• 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

Account Manager

• Making outbound sales calls to current referral sources
• Driving new business in coordination with the Specialty Account Manager (SAM)
• Coordinating with the field SAM to identify and initiate business relationships
• Responding to inbound calls from key referral sources
• Maintaining close contact with key referral sources
• Building business relationships with pharmaceutical sales representatives

Specialty Account Representative

• Responsible for managing service coordination for a designated caseload in specialized programs
• Collaborate with individuals to lead the Person Centered Planning process
• Conduct assessments and create comprehensive Person Centered Support Plans (PCSP)
• Work with Medical Directors and partake in interdisciplinary care rounds
• Engage the individual's support network and oversee management of their health needs
• Document member's service and support goals
• Mentor and assist in the formal training of associates
• Report critical incidents to appropriate parties

LTSS Service Coordinator, Case Manager

• Managing and overseeing a team responsible for coordination of a comprehensive health care program
• Identifying members needs including physical health, behavioral health, and social services
• Managing resource utilization to ensure appropriate delivery of care to members
• Coordinating service delivery to include member assessment of physical and psychological factors
• Participating in cross-functional workgroups to maintain and develop programs
• Evaluating current processes and recommending changes for increased efficiencies and improved outcomes
• Developing and conducting training programs for staff
• Extracting and manipulating analytical data to present findings to relevant markets and stakeholders
• Hiring, training, coaching, counseling, and evaluating direct reports

Manager I – Special Programs

Director

• Develops the provider network through contract negotiations
• Leads associate resources, special projects, or network planning
• Serves as a subject matter expert for local contracting efforts
• Conducts the most complex negotiations
• Prepares financial projections and conducts analysis
• Collaborates with sales team for presentations to employer groups

Provider Network Management Director

• Serving as a liaison, the BA II works closely with Health Plans and their staff to address workflow inquiries
• Responsible for researching and maintaining comprehensive documentation, such as policies, manuals, and contracts
• Crafts validation instructions to guide downstream departments in accurately reviewing claims related to overpayment scenarios
• Manage Ad Hoc recovery initiatives and handle monthly low-complexity recurring leads
• Analyzing recovery reports to enhance claim validation accuracy and identify areas for process improvement

Business Analyst II

IT Support

• Independently leading, supporting and providing direction to an audit team to execute a continuous risk assessment, complex financial/operational audits, strategy and governance reviews, and other special projects for the enterprise, across all lines of business and functions, in accordance with professional and departmental standards.
• Direct administration of multiple audit teams across multiple audits including scheduling, resource management, ensuring quality standards are met, and reporting progress to leadership.
• Lead assessments of complex processes to identify risks, plan audits, perform testing, interpret deficiencies or exceptions, and collaborate with business partners throughout the process.
• Prepare clear and concise audit work papers that summarize scope, methodology and conclusions on assigned audit procedures and provide sufficient evidentiary data to support the work performed.
• Present any irregularities or findings to team leadership along with proposed remediation, timelines and summarize results for executive leadership.
• Monitor and assess the adequacy of remediation, including evaluating action plans, validating corrective actions, maintaining accurate status reporting, and escalating delays or risks, as needed.
• Monitor and coaches audit staff on their audit plans, testing and reporting timely.
• Recommend and assist in the development of skills and knowledge.

Internal Audit Manager

• Manages resource utilization to ensure appropriate delivery of care to members
• adequate coverage for all tasks and job responsibilities
• Coordinates service delivery to include member assessment of physical and psychological factors
• Participates in cross-functional workgroups created to maintain and develop program
• Evaluates current processes of Special Program's support functions; recommends changes for increased efficiencies and improved outcomes
• Develops and conducts training programs for staff involved in the program
• Extracts and manipulates analytical data to present findings to relevant markets and stakeholders
• Hires, trains, coaches, counsels, and evaluates performance of direct reports
• Travel is required

Financial Planning and Analysis

• Maintains compliance activity
• Exceptional customer service and data processing and balancing
• Receives, validates and enters information into finance systems
• Audits documentation for accuracy
• Ensure compliance with regulatory guidelines
• Resolves more routine issues or questions
• Reconciles various system outputs and receives and processes special requests

Sales Support Specialist

LTSS Service Coordinator – RN Clinician, RN Case Manager

Compliance Manager – Infusion

Administrative Assistant, PRN

LTSS Administration Services Coordinator – Lead

Senior Health Information Consultant

Business Analyst III

Specialty Account Representative

LTSS Service Coordinator, Case Manager

Manager I – Special Programs

Provider Network Management Director

Business Analyst II

Internal Audit Manager

Manager I – Special Programs

Financial Operations Technician