Elevance Health

Manager

• This is a field role covering northwestern and southwestern Pennsylvania
• When you are not in the field, you will work virtually from your home
• Travel is required throughout your assigned area(s)
• Establishes relationships and engages with BH providers and ensures measurable improvements in clinical and quality outcomes for members
• Builds relationships with internal clinical and quality departments to ensure high quality care to members and achievement of company HEDIS performance
• Implements strategies that meet clinical, quality, and network improvement goals
• Meets with providers face to face, telephonically and via Teams
• Acts as a liaison between strategic providers and organization to ensure interdepartmental collaboration and coordination of goals
• Supports regional and corporate initiatives regarding Alternative Payment Models (APM), including Value Based Payment (VBP), clinical innovation, and thought leadership
• Creates and maintains linkages between providers of all levels of care, as well as other community-based services and resources
• Partners with network providers and organization stakeholders to operationalize innovative programs and strategies to improve clinical and quality outcomes
• Analyzes provider reports pertaining to cost, utilization, and outcomes, and presents the data to providers and highlights trends
• Identifies data outliers and opportunities for improvement for individual providers
• Identifies high-performing and innovative providers who may be interested in new programmatic or payment models
• Collaborates with regional leadership and network teams to identify providers who are best suited for APMs, preferred provider networks, and/or other aggregate data management programs
• Participates in the identification of opportunities for expansion and development of innovative pilot programs
• Contributes to the identification of best practices and integrates high-quality program ideas/designs into the local market to drive high levels of value
• Provides consultation to providers for clinically complex members as applicable
• Surfaces clinical and quality issues to regional clinical and quality teams and participates in helping to address concerns
• Conducts medical record reviews annually or as needed with network providers across all service levels
• Assists with provider orientations and provider training events in the region, when applicable

Behavioral Health Provider Quality Manager – Field

Events

• Providing compassionate support to children and families involved in the CFSP Foster Care system
• 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
• Works closely with various state agencies

Clinical Care Advisor – Prevention and Preservation

Call Center Representative

• Supports disease management programs and physicians care plans through drug therapy evaluation and consultation
• Evaluates member Rx needs and therapies through review of medication history
• Assesses member compliance with plan via direct contact with members and physicians
• Determines barriers to compliance and identifies solutions
• Ensures members understand appropriate use of prescriptions
• Reviews medications with physicians when therapies do not meet national standards

Pharmacist Consultant, Call Center

• Performing 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.
• 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 plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Assists in problem solving with providers, claims or service issues.
• Functions as preceptor for new care management staff.
• Works on special projects as assigned by manager.
• Other duties as assigned.

RN Nurse Case Manager I

Sales

• Acts as a key member of the sales team to achieve annual sales goals and profitability goals.
• Assists the RFP team with high-level strategy regarding key RFP opportunities and prepares and presents at finalist presentations.
• Develops and maintains partnerships with clients, brokers, and consultants.
• Regularly travels to meet with brokers, consultants, and prospective clients.
• Assists with establishing fees and profitability of prospects.
• Establishes and maintains strong partnerships with key network partners and point solution partners as well as interfaces with key vendors on behalf of AmeriBen, clients, and brokers.
• Cross-sells other services to self-funded groups including Anthem stop loss, CarelonRx, and AmeriBen products that increase profitable revenue.
• Provides subject matter expertise on large group self-funding.
• Partners with account management to ensure successful implementation of new business and renewal of existing business.
• Maintains client and consultant relationships to retain clients year over year.

Sales Director

Analyst

• Employs advanced analytics to gain critical insights into member behavior drivers and preferences
• Consults business leaders and internal partners to apply the insights to test and drive product innovation and enhancement
• Develops and refines analysis templates for problem diagnosis and opportunities assessment
• Contributes to the design of new programs/initiatives based on test/pilot outcomes
• Develops targeting criteria or customer segmentation based on analytical insights
• Develops predictive models and other tools that help target the right members
• Conducts in-depth research to address challenging issues in measuring outcomes
• Leads applied research projects
• Authors white papers and presents at industry conferences

Cost of Care Analyst

Human Resources

• 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.
• Lead projects which impacts data maintenance on HRIS applications.
• Advises HR Business Partners on design and utilization of information systems.
• Collaborates closely with developers, business partners, and vendors on implementation and integration projects.
• Adopts new features in Workday ATS with each annual release.

Senior Workday HR Technology Analyst

• Manages resource utilization to ensure appropriate delivery of care to members.
• Reviews all Care Plans and ISPs for quality control and provides guidance to care managers.
• Ensures care managers provide Trauma-Informed Care and recognize the impact of ACEs.
• Coordinates service delivery to include member assessment of physical and psychological factors.
• Participates in cross-functional workgroups to maintain and develop program.
• Evaluates current processes and 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.

CFSP Licensed Manager, Care Management

Customer Support

• Identify opportunities for engagement of members and their families in forming a supportive, recovery network.
• Develop and implement provision of psychiatric discharge planning education at Recovery and Resiliency sites.
• Collaborate with Stabilization Teams as a member advocate in discharge planning education, resolution of barriers, and service transitions.
• Initiate and maintain contact with assigned individuals and providers to determine member's response to services.
• Teach and role model the value of the member’s recovery experience.
• Model effective coping techniques and self-help strategies.
• Serve as a recovery agent by providing and advocating for recovery-based services to assist the members in daily living.
• Assist members in working with their case manager or treatment team in determining the steps he/she needs to take to achieve these goals and self-directed recovery.
• Assist members in setting up and sustaining self-help (mutual support) groups, as well as means of locating and joining existing groups.
• Utilize tools such as the Wellness Recovery Action Plan (WRAP) to assist clients in creating their wellness and recovery plans.
• Assist clients in developing empowerment skills and combating stigma through self-advocacy.

Peer Support Specialist, Certification Required

Director

• Serve as a trusted advisor and thought partner to the Senior Leadership Team
• Champion the integration of human-centered design and digital transformation principles
• Partner with business and HR leaders to activate organizational strategies
• Leverage data analytics for actionable insights into organizational health
• Design and build custom tools and AI-powered knowledge solutions
• Provide expert consultation to business leaders to enhance team effectiveness
• Influence workforce and succession planning, competency modeling, and talent programs
• Lead and manage large-scale programs to build OD&E capability

Organizational Design & Effectiveness Director – Enterprise Center of Excellence

Security Engineer

• Produce executive-ready, audit-defensible architecture documentation (standards, reference architectures, patterns, roadmaps, and decision records)
• Own and evolve the enterprise security architecture vision for AI-enabled, cloud-first, Zero Trust-aligned platforms
• Define and drive Zero Trust architecture patterns aligned to NIST Zero Trust Architecture (SP 800-207) and CISA Zero Trust Maturity Model
• Maintain, evolve, and expand enterprise AI security architecture and guardrails aligned to NIST AI RMF 1.0
• Define and maintain secure-by-default cloud reference architectures across AWS/Azure and GCP
• Partner in lockstep with Enterprise Architecture and OCISO stakeholders to operationalize governance
• Chair and operate the Security Architecture Review Board (SARB)
• Develop and deliver concise, executive-ready briefings that translate security architecture tradeoffs into business impact

Enterprise Principal Security Architect

• 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

• Managing psychiatric and substance abuse treatment benefits through telephonic or written review
• Assessing member needs to ensure access to quality behavioral healthcare
• Coordinating and evaluating case planning to promote effective use of health benefits
• Performing psychiatric and substance abuse assessments as needed

Behavioral Health Care Manager I

• Perform case management telephonically and/or through home visits within the scope of licensure for special programs like Foster Care.
• Assess and identify appropriate foster home placements considering each child's specific needs and circumstances.
• Develop comprehensive care plans to address objectives and goals identified during assessments.
• Facilitate pre-placement visits and introductions to help children and families transition smoothly.
• Coordinate with internal and external resources to meet the integrated (physical and behavioral) whole person care needs of the member.
• Maintain strong relationships with foster families, providing support and guidance throughout the placement process.
• Support members' access to appropriate quality and cost-effective care, modifying plans as needed.
• Maintain accurate records of placements and communications following organizational and legal requirements.

Placement Support Specialist, Region 5

• Conduct service coordination functions for a defined caseload
• 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 individual’s health needs
• Perform face-to-face program assessments and manage cases
• Document members’ service and support goals
• Submit utilization/authorization requests and report critical incidents
• Assist in appeal or fair hearings as needed