Elevance Health

General Counsel

• Responsible for leveraging in-depth knowledge of a legal specialty or area of law
• Provide advice and recommendations to executives and management on highly complex matters
• Carry out research of legal principles and precedents
• Consult with outside counsel on legal strategies on particular issues
• Use professional legal theories and best practices to contribute to the development of company's concepts and principles
• Provide general and detailed instructions for more junior members of the department
• Confer with other senior leaders including ELT members
• Work on extremely complex and multifaceted problems
• Develop methods, approaches, and evaluation criteria for obtaining results
• Provide ad hoc work direction and supervision to other legal staff
• Assess and mitigate risk on even the most difficult and challenging issues
• Manage high-level organizational risks

Senior Associate General Counsel

Consultant

• develops responses for complex Requests for Proposals (RFPs)
• conducts initial review of RFPs/RFIs and surveys
• organizes and participates in strategy meetings with senior sales personnel
• writes and proofreads final deliverables
• develops and writes targeted Executive Summaries
• oversees the entire production process
• manages each project to completion
• engages in ongoing communications with Sales Director/Officer
• researches and gathers information internally and externally
• obtains and develops supporting materials and documentation
• partners with the creative staff to choose artwork
• oversees and directs production staff to produce materials by deadline

Proposal Development Consultant

Manager

• Responsible for conducting service coordination functions for a defined caseload of individuals in specialized programs
• Facilitate the Person Centered Planning process
• Conduct assessments and develop comprehensive Person Centered Support Plan (PCSP)
• Interface with Medical Directors and participate in interdisciplinary care rounds
• Engage the member’s circle of support and manage physical health/behavioral health/LTSS needs
• Perform face to face program assessments
• Identify members with potential clinical health care needs and coordinate their cases
• Manage non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities
• Document short and long-term service and support goals in collaboration with care team
• Identify members that would benefit from an alternative level of service or other waiver programs
• Mentor, assist in training new staff, and involve in process improvement initiatives
• Submit utilization/authorization requests to utilization management

LTSS Service Coordinator – Case Manager, Region D

• Responsible for conducting service coordination functions for a defined caseload of individuals in specialized programs.
• Facilitates the Person Centered Planning process that documents the member’s preferences, needs and self-identified goals.
• Conduct assessments, develop a comprehensive Person Centered Support Plan (PCSP) and backup plan.
• Interface with Medical Directors, participate in interdisciplinary care rounds to support development of fully integrated care plan.
• Engage the member’s circle of support and manage the individual’s physical health (PH)/behavioral health (BH)/LTSS needs.
• Perform face to face program assessments using various tools with pre-defined questions.
• Apply motivational interviewing techniques for evaluations, coordination, and management of an individual’s waiver.

LTSS Service Coordinator, Case Manager – Region C: Pasco/Pinellas

• responsible for care management within the scope of licensure for members with complex and chronic care needs
• assesses, develops, implements, coordinates, monitors, and evaluates care plans designed to optimize member health care across the care continuum
• interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans
• negotiates rates of reimbursement, as applicable
• assists in problem solving with providers, claims or service issues

Lead Nurse Case Manager

• Conducting service coordination functions for a defined caseload of individuals in specialized programs
• Facilitates the Person Centered Planning process
• Performs face to face program assessments
• Applies motivational interviewing techniques for evaluations
• Coordination and management of an individual’s waiver
• Identifies members with potential clinical health care needs
• Manages non-clinical needs of members with chronic illnesses
• Documents service and support goals in collaboration with the member’s chosen care team
• Identifies members that would benefit from an alternative level of service
• Submits utilization/authorization requests to utilization management
• Responsible for reporting critical incidents

LTSS Service Coordinator – Case Manager, Region A: Bay/Escambia/Santa Rosa

Analyst

• Reviewing, auditing, and coding medical records for reimbursement
• Auditing and reviewing medical documentation for appropriate ICD-9 and CPT coding and documentation
• Querying physicians for unclear code assignments
• Training and educating others on coding documentation and payment guidelines
• Reviewing CPT and ICD-9 codes annually for accuracy and implementing changes
• Assisting physicians and providers with coding and billing questions

Senior Coding Analyst

• Hires, trains, coaches, counsels, and evaluates performance of direct reports
• Adheres to the best practice model for all facets of program operations
• Collaborates with management team to support alignment across coordination teams
• Mentor direct reports to apply Independence First principles through appropriate service allocation determinations
• Ensures adequate coverage for all tasks and job responsibilities
• Coordinates service delivery of assigned team to include member assessments, care planning, and ongoing contacts
• Participates in cross-functional workgroups to maintain and enhance the program
• Evaluates current processes of Special Program's support functions; recommends changes for increased efficiencies and improved outcomes
• Identifies training needs for coordination teams
• Effectively communicates risks, status of team performance, and support needs to leadership
• Utilizes performance data to support team with consistent compliance with key program metrics

Manager I – GBD Special Programs

• Conducting service coordination functions for a defined caseload of individuals in specialized programs
• Facilitating 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
• Supporting the 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
• Performing face to face program assessments, applying motivational interviewing techniques for evaluations, coordination, and management of an individual’s waiver
• Identifying members with potential clinical health care needs and coordinating those member’s cases
• Managing non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities
• Documenting the member's short and long-term service and support goals in collaboration with the member’s chosen care team
• Identifying members that would benefit from an alternative level of service or other waiver programs
• Serving as mentor, subject matter expert or preceptor for new staff
• Assisting in the formal training of associates and may be involved in process improvement initiatives
• Submitting utilization/authorization requests to utilization management
• Responsible for reporting critical incidents to appropriate internal and external parties

LTSS Service Coordinator – Case Manager

• Conducting service coordination functions for a defined caseload of individuals in specialized programs
• Facilitates the Person Centered Planning process
• Conduct assessments, develop comprehensive Person Centered Support Plans
• Interfacing with Medical Directors and participating in interdisciplinary care rounds
• Engaging members' circle of support and managing their physical and behavioral health needs
• Manages non-clinical needs of members with chronic illnesses and disabilities
• Documents short and long-term service and support goals in collaboration with members’ chosen care team

LTSS Service Coordinator, Case Manager

Financial Planning and Analysis

• Managing the enterprise wide planning process for a VP and above
• Advancing payment integrity strategy
• Strengthening end-to-end processes
• Driving measurable improvements in cost avoidance, recovery, and prevention
• Directing the monthly/quarterly reporting process and annual operating plan development
• Ensuring alignment with payment integrity performance goals
• Developing the annual business plan and quarterly forecast materials
• Coaching business planning participants on requirements, analysis, and deadlines
• Managing strategic payment integrity projects, reports, and analyses

Strategic Planning Director – Payment Integrity

Strategy

• Understands all aspects of the business
• Partners with executive leadership to define strategy and successful criteria for the future
• Identifies and proposes opportunities to improve initiative’s results
• Translates strategy into defined tactics, programs/projects priorities, and timelines
• Ensures alignment and attainment of enterprises strategic plans
• Documents strategic priorities and reports on customer insight research initiatives
• Builds and leverages relationships to provide innovative solutions
• Responsible for the development, implementation, and monitoring of line of business planning and project activities
• Supports the internal operations of the Product Delivery Center of Excellence
• Supports senior leadership with establishing program design, success criteria, guiding principles, and governance structures.

Business Strategy & Execution Director

• Responsible for conducting service coordination functions for a defined caseload of individuals in specialized programs
• Facilitates the Person Centered Planning process that documents the member’s preferences, needs and self-identified goals
• Conducts assessments, development of a comprehensive Person Centered Support Plan (PCSP) and backup plan
• Interfaces with Medical Directors and participates in interdisciplinary care rounds to support development of a fully integrated care plan
• Engages the member’s circle of support and overall management of the individual's physical health (PH)/behavioral health (BH)/LTSS needs
• Performs face to face program assessments for identification, applying motivational interviewing techniques for evaluations, coordination, and management of an individual’s waiver needs
• Uses tools and pre-defined identification process to identify members with potential clinical health care needs
• Coordinates members’ cases with the clinical healthcare management and interdisciplinary team for care coordination support
• Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities
• Documents short and long-term service and support goals in collaboration with the member’s chosen care team
• Identifies members that would benefit from an alternative level of service or other waiver programs
• May also serve as mentor, subject matter expert or preceptor for new staff
• Submits utilization/authorization requests to utilization management with documentation supporting and aligning with the individual’s care plan
• Responsible for reporting critical incidents to appropriate parties such as state and county agencies
• Assists and participates in appeal or fair hearings, member grievances, appeals, and state audits

• Conducting service coordination functions for a defined caseload of individuals in specialized programs.
• Facilitates the Person Centered Planning process that documents the member’s preferences, needs and self-identified goals.
• Conducts assessments, develops a comprehensive Person Centered Support Plan (PCSP) and backup plan.
• Interfacing with Medical Directors and participating in interdisciplinary care rounds.
• Engaging the member’s circle of support for overall management of their needs.
• Perform face to face program assessments for identification, applying motivational interviewing techniques.
• Coordinate and manage individual’s waiver and BH or PH needs.
• Identify members with potential clinical health care needs and coordinate those member’s cases.
• Manage non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities.
• Document the member’s short and long-term service and support goals.
• Identify members that would benefit from an alternative level of service or other waiver programs.
• May serve as mentor, subject matter expert or preceptor for new staff.

Risk

• Gather, format, and load metadata under supervision
• Troubleshoot simple metadata repository problems
• Participate in quality reviews and maintenance of vendor supplied software
• Create and maintain developer documentation
• Collect, clean, catalog, maintain, and deliver master data with guidance
• Perform system administration duties such as user management and performance monitoring
• Conduct data profiling and data quality analysis with supervision

Senior Associate General Counsel

Proposal Development Consultant

LTSS Service Coordinator – Case Manager, Region D

LTSS Service Coordinator, Case Manager – Region C: Pasco/Pinellas

Lead Nurse Case Manager

LTSS Service Coordinator – Case Manager, Region A: Bay/Escambia/Santa Rosa

Senior Coding Analyst

Manager I – GBD Special Programs

LTSS Service Coordinator – Case Manager

LTSS Service Coordinator, Case Manager

Strategic Planning Director – Payment Integrity

Business Strategy & Execution Director

LTSS Service Coordinator – Case Manager

LTSS Service Coordinator – Case Manager

Data Admin Analyst II / Data Governance Operations Analyst