Elevance Health

Manager

• Develops the provider network through contract negotiations (language and rates)
• Assists in recruiting providers into the network
• Works with less-complex providers
• Travels to worksite and other locations as necessary

Provider Network Manager

• Overall management of member's case within the scope of licensure
• Develops, monitors, evaluates, and revises the member's care plan to meet the member's needs
• Performs face-to-face clinical assessments for identification, evaluation, coordination, and management of member's needs
• Manages members with chronic illnesses, co-morbidities, and/or disabilities
• Establishes short and long term goals in collaboration with members and their supports
• Directs and supervises the work of LPN/LVN and other licensed professionals in coordinating services

LTSS Service Coordinator – RN Clinician, RN Case Manager

Sales

• Provides administrative support to the sales teams which supports the selling, servicing, and retaining activities for brokers and clients
• Partners with proposal units request for proposal (“RFP”) responses to brokers and groups and maintains various system updates for proposal and sales activity
• Researches and resolves routine sales, claims and benefit issues
• Inputs and tracks sales data to ensure accuracy
• Generates and reviews periodic and ad hoc sales reports for brokers, clients, and sales teams
• Recommends changes in procedures or methods in areas that affect the team
• Engages and fosters relationships both internally and externally
• Completes special projects as requested by the sales teams

Sales Support Coordinator II

Technical Program Manager

• Responsible for the development and ongoing management of one or more multi-year programs
• Manages Enterprise-wide programs of $7M - $10M+ size with multiple concurrent sub-projects
• Coaches and mentors project team members and project managers
• Develops resource, risk, quality, cost, and scope management plans
• Defines, recommends and secures contractual agreements for technical services and products

Auditor

• Participating in auditing and contract adherence activities to ensure the Long Term Services and Supports program adheres with applicable state laws and contractual requirements
• Prepares and ensures completion of internal and external audits, adherence reporting and tracking/monitoring processes as assigned
• Audits LTSS work to ensure appropriate and consistent administration of contract requirements
• Performs external audits including enrollee record review, new member and short term stay, MCO to MCO, Level of Care and Employment and Community First audits
• Responds to on demand state audit requests
• Responsible for Annual Quality Survey and Annual Network Audit reviews, audit participation and presents audit results
• Provides internal Person Centered Support Plan auditing and comprehensive adherence auditing
• Documents audit findings in a timely, accurate and concise manner
• Tracks activities such as daily critical incident submissions, short term stay, Individual Experience, Employment and NCI surveys and caseload tracking
• Ensures clinical licensure adherence with contract requirements
• Completes monthly reports such as short term stay, caseload staffing and ratio reporting
• Responds to legislative inquiries and other on demand request per contract agreement
• Maintains knowledge of tracking tools and databases, and prepares reports to document contract adherence issues
• May educate staff about contract requirements to ensure contract adherence
• Participates in projects, initiatives and process improvement activities
• May serve as an internal resource, mentor and coach for new associates

LTSS Contract Adherence Auditor

Executive Assistant

• Writes and routes confidential correspondence
• Screens, handles or distributes incoming phone calls and complaints
• Maintains confidential correspondence and general files
• Orders supplies
• Prepares and tracks budgets
• Coordinates travel plans
• Submits expense reports
• Compiles and distributes meeting minutes
• Compiles information for reports, documents and proposals
• Collates and assembles materials, makes arrangements for meetings/presentations
• Organizes chart updates
• Prepares forms and reviews documentation for conformance with internal policies and procedures
• Utilizes various software packages such as spreadsheet, word processing, data base and graphics to produce high quality reports, presentations and documents
• Researches, verifies and prepares reports
• Creates and maintains databases
• Performs diversified and confidential administrative duties requiring comprehensive skill and knowledge of organization policies and procedures

Executive Administrator

Analyst

• Develop statistical subject matter expertise of the research data and integrated environment
• Lead and support statistical analysis with application of research methods in emerging real-world data sources and clinical research
• Assist in reviewing and advising on data management activities (e.g., database/cohort identification, analytic file development, case report form (CRF) programming, validation checks, data issues resolutions)
• Support development of statistical content for study documentation (e.g., protocols, statistical analysis plans), reports, publications and regulatory submissions
• Perform execution of analytic methodology, including writing programming specifications, developing programs to perform statistical analysis, creating Tables, Listings and Figures (TLFs), and performing quality control of programs and ensuring integrity of analysis
• Formulate ideas for new research studies and projects and contribute analytic insight to the writing of research proposals
• Articulate methods, process, progress and results to internal and external stakeholders
• Collaborate with the Scientific and Project Management teams to ensure adherence to scope, schedule, and budget commitments

Biostatistical Analyst

Security Engineer

• Analyzes, designs, develops, and maintains HRIS solutions to address complex and varied business process needs.
• Develops or collaborates with Development 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.
• Leads projects which impacts data maintenance on HRIS applications.
• Advises HR Business Partners on design and utilization of information systems.
• Manages program and project implementations.
• Provides direction and guidance to team members and serve as an expert for the team.

Workday Security Consultant

Program Manager

• Own the end-to-end lifecycle of external Pharma and Payer data feeds and reporting services
• Manage and optimize a fee-for-service business model delivering ~$13M+ annually
• Optimize data feed strategy post integration
• External Partner & Vendor Management serving as the primary day-to-day relationship owner
• Maintain strong partnerships to ensure continuity, data quality, contract adherence, and timely issue resolution
• Support contract negotiations and ongoing performance management in collaboration with trade, legal, and procurement teams

Program Director, External Data Products

• Responsible for conducting service coordination functions for a defined caseload of individuals in specialized programs.
• In collaboration with the person supported, facilitates the Person Centered Planning process that documents the member’s preferences, needs and self-identified goals.
• Conducting assessments.
• Development of a comprehensive Person Centered Support Plan (PCSP) and backup plan.
• Interfacing with Medical Directors and participating in interdisciplinary care rounds to support development of a fully integrated care plan.
• Engaging the member’s circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS needs, as required by applicable state law and contract, and federal requirements.

LTSS Service Coordinator – Case Manager

• Identifying issues and/or entities that may pose potential risk associated with fraud and abuse
• Examines claims for compliance with relevant billing and processing guidelines
• Reviews and conducts analysis of claims and medical records prior to payment
• Researches new healthcare related questions as necessary to aid in investigations
• Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern
• Recommends possible interventions for loss control and risk avoidance

Clinical Provider Auditor I

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

Financial/Accounting Operations Specialist – Stop Loss

Product Manager

• Develops, implements, and maintains competitive risk products.
• Partners with business and product leaders to achieve superior execution of product strategy in the marketplace.
• Tracks individual product performance by benefit design, market segment, and sub region.
• Supports development of short- and long-term strategic product plans in support of market, sales, and profitability objectives.
• Identifies system needs to support short- and long-term product strategy.
• Develops system requirements and ROI.
• May lead efforts or manage project teams in the implementation of complex regional and companywide initiatives.

Senior Risk Product Management Director

• Responsible for the development and ongoing management of one or more multi-year external client facing programs
• 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

Events

• Providing compassionate support to children and families involved in the CFSP Foster Care system, with a primary emphasis on strengthening family bonds and delivering services to those at risk of entering foster care.
• Conducts assessments to identify individual needs.
• Develops comprehensive care plan to address objectives and goals as identified during assessment.
• Supports member access to appropriate quality and cost effective care and modifies plan(s) as needed.
• Coordinates with internal and external resources to meet identified needs of the member in terms of integrated (physical and behavioral) whole person care.
• Coordinates social determinants of health to meet the needs of the member and incorporates that into care planning.
• Works closely with various state agencies.
• Maintains knowledge of the system of care philosophy; a spectrum of effective, community-based services and supports for those with or at risk for mental health or other challenges and their families, that is organized into a coordinated network.
• Builds meaningful partnerships with designated populations and their families, and addresses cultural and linguistic needs, in order to help them function better at home, in the community, and throughout life.
• Evaluates health needs and identifies applicable services and resources in conjunction with members and their families.
• Provides important information including patient education, medication reconciliation, and identification of community resources and assists with arrangement of follow-up care.