Elevance Health

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

Customer Support

• Answer inbound calls to the Member Services Department using the Plan’s standard greeting
• Respond to caller’s inquiries and resolve member, vendor, and provider requests for information and member materials
• Provide accurate information to callers regarding benefits, Member Handbook, and other requested information
• Research, identify, and resolve caller’s complaints using applicable resources and systems
• Warm transfer calls to appropriate individuals, as required
• Identify and escalate issues, as appropriate
• Document all call outcomes in the electronic medical record system
• Maintain and update member records with pertinent information, as necessary
• Advise Members of the Plan’s grievance and appeals processes, the service authorization process, and the Member’s right to a fair hearing and/or external review
• Develop and maintain effective working relationships with members, service providers, and all members of the care management team
• Facilitate language translation and communications assistance for callers requiring special accommodations

Customer Care Representative

Content Writer

• Provide writing support for the development and implementation of moderately complex provider communication materials
• Consults with business owners to clarify content needs when creating final draft documents
• Writes, edits, and reviews content for traditionally printed material (business development, form letters, direct mail, etc.) and/or digital material (website copy, email communications, etc.)
• Ensures all materials meet internal and external business, regulatory and legal standards, and follows appropriate corporate standards, guidelines, and approval processes
• Identifies improvements/efficiencies that support operational excellence, and supports business initiatives (plain language, standardization, going paperless, etc.)

Provider Communication Writer

Medical Director

• Administration of physical and/or behavioral health medical services
• Ensure appropriate and cost-effective medical care
• Develop and implement programs to improve quality, cost, and outcomes
• Provide clinical consultation and serve as advisory to enhance clinical operations
• Identify cost of care opportunities
• Serve as a resource to staff including Medical Director Associates
• Represent the company to external entities

Medical Director – Family or Emergency Medicine

Recruitment

• Act as the primary liaison between Talent Acquisition, Developers, and vendors to translate recruiting needs into Workday solutions
• Analyze, configure, and maintain Workday Recruiting (ATS) functional configuration to support complex and evolving processes
• Serve as Product Expert or functional partner, collaborating with Product Owner and Scrum Master in managing priorities, enhancements, and system roadmap
• Participate in Workday release activities, including feature evaluation, adoption, and implementation
• Support integrations between Workday and recruiting technologies, ensuring reliable data exchange and minimal disruption to operations
• Partner with developer to maintain integrations across platforms such as Paradox (career site and scheduling), HiredScore, HireRight, Broadbean, AON, DocuSign, tax credit vendors, and MS365 (Outlook/Teams)
• Partner with developers and vendors to troubleshoot issues, perform root cause analysis, and drive timely resolution
• Balance production support with delivery of new features and enhancements across Workday and integrated technologies
• Participate in the implementation of new solutions (e.g., AppCast), ensuring seamless data flow for requisitions, candidates, and applications
• Provide expert support to recruiters and advise Talent Acquisition on system capabilities and process improvements

Senior Workday HR Technology Analyst – Recruiting

Consultant

• Manages 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 business issues
• Researches applicable subject matter practices and remains aware of industry trends
• Manages relationships and partners with corporate and regional business areas
• coordinates training related to the external client facing program
• develops program success measures and performs periodic assessments of external client facing program success
• Own the end-to-end delivery of FWA reporting and program operations
• Ensure accuracy, integrity, and timeliness of all reporting outputs

Program Consultant

Sales

• Achieves sales effectiveness by meeting or surpassing business unit revenue, referral growth, admissions, margin, and profitability goals.
• Produces sales results, provides strategic and operational direction, and develops trusting relationships with physician offices, specialty referral sources, and customers.
• Manages and coaches a field-based sales team to leverage relationships, drive referrals, expand new accounts, and support growth within targeted specialty markets including neurology and immunology.
• Partners with key stakeholders on strategic planning, specialty growth initiatives, and implementation of operational process flows across infusion care settings.
• Communicates information regarding competitors, market dynamics, referral trends, and issues affecting the business to leadership and/or team.
• Develops and executes sales meetings, field coaching, ride-alongs, and training initiatives to improve sales effectiveness and territory performance.
• Collaborates with peers and cross-functional partners to continuously improve programs, sales execution, and customer experience.
• Travels extensively throughout assigned regions to provide in-field leadership, coaching, and relationship management support.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Director, Infusion Sales – CarelonRx

• Responsible for the appeal reviews for physical health medical services
• Supports clinicians to ensure timely and consistent responses to members and providers
• Provides guidance for clinical operational aspects of a program
• Conducts peer-to-peer clinical case reviews with attending physicians
• Serves as a resource and consultant for other areas of the company
• May chair company committees
• Interprets medical policies and clinical guidelines
• Identifies and develops opportunities for innovation to increase effectiveness and quality

Appeals Medical Director – Cardiology

Outside Sales

• meeting monthly sales goal for an assigned territory through the development and implementation of a strategic sales plan
• Sells and promotes Senior Services products by coordinating and delivering formal sales presentations to consumer groups
• arranges private appointments in the customer’s homes
• making outbound phone calls to prospects
• managing temporary support staff
• managing customer records in the automated lead tracking system according to the departments standards
• Identifies opportunities within the territory to generate leads
• Cross sells specified products from other departments
• Provides member retention services to existing customers
• Travels to worksite and other locations as necessary, as well as evening and weekend hours

Medicare Field Sales & Service Representative

Pharmacist

• Collaborating with healthcare providers and/or pharmacists
• Driving personalized health management and improving health outcomes
• Performing care management activities within the scope of licensure
• Ensuring medically appropriate, high quality, cost-effective care
• Interpreting appropriateness of care and intervention planning
• Conducting clinical assessment to develop and implement care plans
• Monitoring and evaluating effectiveness of care management plans

Telephonic Clinical Nurse Coordinator – BioPlus Specialty Pharmacy

• Reviews accuracy and completeness of prior authorization information requested
• ensures supporting documents are present and meet company set standards
• Assists with the completion of medical necessity documentation to expedite approvals
• ensures that appropriate follow up is performed
• Collaborates with other departments to assist in obtaining prior authorizations/appeals
• Document insurance company interactions and all prior authorization information in the system
• Reviews insurance denials and submits appeals as permitted by payor
• Contacts physician offices as needed to obtain demographic information or medical data

Authorization Representative II – BioPlus Specialty Pharmacy

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, involving those outside the unit
• 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
• Lead discovery and requirements refinement sessions to uncover customers’ business, functional requirements and synthesize requirements to create clear and comprehensive high level and detail business requirements with acceptance criteria

Business Analyst III

Manager

• 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.
• Ensure compliance with healthcare regulations and monitor adherence to contractual obligations.
• Ability to handle unexpected changes in assignments and members needs and manage a flexible schedule accommodating field visits and emergency situations.
• Valid driver’s license, reliable transportation, and ability to travel within the service area as needed.
• Conduct facility, hospital, or home visits to monitor and evaluate care as applicable and/or required.
• Maintaining meticulous records of interactions, decisions, and care plans for compliance and audit purposes.
• Proficiency in using mobile devices, multiples systems, and technology to access member records, document visits and reports, and communicate with the central office.
• Competence in addressing quickly arising issues effectively, often requiring creative and immediate solutions.

Nurse Case Manager

• Drives profitability at the district and infusion centers level by effectively leading frontline associates
• Manages sales activities to produce desired sales results established leadership
• Oversees pre-call plans and contact reports through client relationship management (CRM)
• Travels extensively
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Hemophilia District Sales Manager – East Coast

• Provides writing support for the development and implementation of moderately complex provider communication materials
• Consults with business owners to clarify content needs when creating final draft documents
• Writes, edits, and reviews content for traditionally printed material and/or digital material
• Ensures all materials meet internal and external business, regulatory and legal standards
• Identifies improvements/efficiencies that support operational excellence