Elevance Health

Manager

• Responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
• Performs duties telephonically or on-site such as at hospitals for discharge planning.
• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• 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.

Nurse Case Manager I

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• 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.
• Assists with development of utilization/care management policies and procedures.

Nurse Case Manager II

Customer Support

• 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 members and incorporates that into care planning.
• Works closely with various state agencies.
• Maintains knowledge of the philosophy system of care; a spectrum of effective, community-based services and support 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, 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

Emergency Placement Support Specialist – Weekend Shift

Analyst

• Researches, extrapolates, compiles and validates data on flows, systems, coding, and testing problems and processing issues
• Makes recommendations for process changes and works with management to obtain sign-off and to implement
• Develops and updates flows and end-user documentation based on research and system changes
• Facilitates issues meetings
• Assists in managing intranet site by uploading procedures and maintaining a daily bulletin

Senior Documentation Analyst – Information Mapping

Consultant

• Creates and maintains databases to track business performance.
• Analyzes data and summarizes performance using summary statistical procedures.
• Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
• Creates and publishes periodic reports, as well as any necessary ad hoc reports.
• May require taking business issues and devising the best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.
• May make recommendations based on data analysis.
• Provides analytic consultation to other business areas, leadership, or external customers.
• Data analysis and reporting encompasses a much higher level of complexity.

Provider Analytics Consultant

• Ensures effective psychosocial intervention positively impacting patients' ability to manage chronic illness
• Utilizes community, government, and/or client resources to address participants' limitations
• Manages behavioral and psychosocial needs
• Assists members to effectively utilize available resources for personal health needs
• Evaluates members' ability to manage self and locate alternative resources
• Provides guidance seeking alternative solutions to specific problems
• Evaluates strengths for health self-management and develops strategies for healthcare needs

Social Work Case Manager

• Calculates stop loss rates for large complex cases based on thorough analysis of experience, location, demographics, etc.
• Coordinates with other departments to ensure accuracy and consistency of overall account reporting.
• Proposes rates for prospective business utilizing a combination of other carrier experience, demographic data and manual rates.
• Performs post-sale reviews.
• Prepares or supervises preparation of annual settlements, rate projections, or benefit change increments and decrements.
• Surveys existing product portfolios by market, monitors sales results, trends and needs, recommends product portfolio changes.
• Assists in establishing rating and administrative procedures.
• Participates in major multi-functional teams as underwriting representative.
• Assists in the technical development of underwriting associates, which may include monitoring reports and work flow to provide recommendations on productivity and efficiency improvements.
• Updates and monitors departmental processes and procedures in compliance with system, regulatory and business requirements.

Senior Stop Loss Group Underwriter Consultant

Pharmacist

• Responsible for ensuring successful implementation of high-quality performance solutions to the company and/or specific clients.
• Manages a team of Learning & Development associates responsible for the delivery of learning solutions to meet client needs and objectives.
• Consults with clients to understand strategic objectives.
• Oversees the consistent practice of performance consulting with clients to identify the root causes of performance gaps.
• Ensures alignment of local efforts with Enterprise strategic objectives.
• Oversees the formulation of teaching outlines, instructional methods, and/or teaching aids.
• Ensures courses and other educational information support the overall business objectives.
• Oversees the utilization of performance consulting skills in the development of training materials for associates.
• May conduct training sessions for clients or Learning & Development associates.
• Oversees the implementation of effective training feedback mechanisms to improve training programs and to assess the impact of the investment made in training.
• Partners with the Director to develop and implement market or business segment training strategy that aligns with the departmental/enterprise Learning & Development strategy.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Manager I, Learning – BioPlus Specialty Pharmacy

• Telephonic Nurse Case Manager I is 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 designed to optimize member health care across the care continuum
• Performs duties telephonically for discharge planning
• Ensures member access to services appropriate to their health needs
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements
• Coordinates internal and external resources to meet identified needs
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary
• 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

• Achieves sales of new accounts while maintaining relationships with existing accounts
• Utilizes databases to identify key accounts and maximize referral potential
• Develops and fosters account relationships and maintains a call cycle
• Partners with leadership to execute business objectives

Regional Account Liaison – BioPlus Specialty Pharmacy

• Manages resource utilization to ensure appropriate delivery of care to members
• 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

Manager I – GBD Special Programs LTSS

General Counsel

• managing a large litigation caseload
• working closely with outside litigation counsel and internal business staff and leaders
• providing legal advice and recommendations for initiatives and projects
• working as a strategic partner and decision maker with senior leaders
• determining methods and procedures on new assignments

Associate General Counsel – Litigation

• Develops and executes the regional sales strategy for BioPlus Specialty Pharmacy
• Maintains sales effectiveness through regular in-person meetings with healthcare providers
• Utilizes databases and Salesforce to analyze performance metrics
• Develops account relationships and ensures effective communication
• Supports specialty pharmacy activity with educational resources
• Participates in sales meetings, conferences, and training programs

Underwriter

• Determines acceptability of medically underwritten risks for complex cases
• Calculates appropriate group/individual premium rates for new business and renewal
• Proposes new business rates for complex cases ensuring rating compliance
• Calculates renewal rates for complex cases utilizing a thorough analysis of medical experience
• Evaluates medical information to assign appropriate underwriting decision
• Monitors rating compliance reporting with actuaries for assigned business
• Analyzes and responds to written and verbal underwriting inquiries
• Participates in and may lead special underwriting projects
• Interacts frequently with brokers, sales, administration and actuarial areas

Clinical Medical Review – Oncology

Administrative Assistant

• Writes and routes confidential correspondence
• Screens, handles, or distributes incoming phone calls and emails
• Maintains confidential correspondence and general files
• Schedules meetings, maintains calendar of VP and/or leadership team
• Coordinates travel plans
• Submits expense reports
• Prepares statements of work, requisition requests, and check payment/invoice requests
• Compiles and distributes meeting minutes
• Researches, verifies, and prepares reports
• Performs diversified and confidential administrative duties

Nurse Case Manager I

Nurse Case Manager II

Emergency Placement Support Specialist – Weekend Shift

Senior Documentation Analyst – Information Mapping

Provider Analytics Consultant

Social Work Case Manager

Senior Stop Loss Group Underwriter Consultant

Manager I, Learning – BioPlus Specialty Pharmacy

Nurse Case Manager I

Regional Account Liaison – BioPlus Specialty Pharmacy

Manager I – GBD Special Programs LTSS

Associate General Counsel – Litigation

Regional Account Liaison – BioPlus Specialty Pharmacy

Clinical Medical Review – Oncology

Executive Administrative Assistant I