Elevance Health

Customer Support

• 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 – Regions 6/7

Analyst

• providing analytical support to the Cost of Care and/or Provider Contracting organizations
• lowering claims costs
• improving the quality of care
• increasing member and provider network satisfaction
• developing moderately complex ROI models
• performing healthcare cost analysis to identify strategies to control costs
• projecting cost increases in medical services by using analytic techniques
• preparing pre-negotiation analyses
• performing modeling to compare various contract scenarios
• measuring and evaluating the cost impact of negotiation proposals
• researching financial profitability/stability and competitive environment of providers
• identifying cost of care savings opportunities
• recommending policy changes
• reviewing results post-implementation to ensure projected cost savings are realized
• educating provider contractors on contracting analytics

Senior Provider Contract Cost of Care Analyst

Manager

• Responsible for performing telephonic and face-to-face functional assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health, social services and long term services and supports.
• Identifies members for high risk complications and coordinates care in conjunction with the member and the health care team.
• Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.
• Obtains a thorough and accurate member history to develop an individual care plan.
• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs.
• The RN has overall responsibility to develop the care plan for services for the member and ensures the member's access to those services.
• May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible.

LTSS Service Coordinator – RN Clinician, RN Case Manager

• Provides strategic planning and account management for large accounts
• Directs and manages administration of contractual requirements and obligations
• Manages new and renewal implementation processes for accounts
• Interfaces with operations for smooth service delivery
• Maintains ongoing account relationships at multiple levels in the customer organization
• Makes recommendations for improvements to meet customers' expectations
• Develops implementation processes and manages reporting processes for client retention and satisfaction
• Provides on-site and off-site account management
• Interprets plan design, researches and resolves inquiries, claims, benefits and enrollment issues
• Presents utilization and benefit reporting to broker and client
• Coordinates open enrollment meetings, renewal processes and training sessions
• Participates in efforts to support standardization across accounts
• Works in multi-disciplinary teams for product and operational enhancements
• Provides guidance to less experienced account service managers
• Makes routine account visits

Senior Account Service Manager

Project Manager

• Provides foundational project delivery for a newly-created Carelon Insights Reporting and Analytics (CIRA) team
• Works with business partners to identify and implement small to medium projects that support achievement of goals
• Applies project management knowledge, skills, tools and techniques to project deliverables, processes, and systems
• Manages the development of a prescribed planning document
• Partners with sponsors to secure project approval
• Develops communication management plan
• Defines project team roles and responsibilities
• Develops deployment plan
• Leads project meetings
• Identifies, documents and prioritizes scope changes
• Executes small to medium projects using established methodologies
• Maintains and updates all project documents
• Provides performance feedback to team members and resource managers
• Tracks and manages time and budget against plan
• Conducts project close-out activities

• Responds to more complex cases and account specific requests
• Uses appropriate screening criteria knowledge and clinical judgment to assess member needs
• Conducts assessments to identify individual needs and develops specific care plan to address objectives and goals as identified during assessment
• Monitors and evaluates effectiveness of care plan and modifies plan as needed
• Supports member access to appropriate quality and cost effective care
• Coordinates with internal and external resources to meet identified needs of the members and collaborates with providers
• Serves as a resource to other BH Case Mgrs
• Participates in cross-functional teams projects and initiatives

Behavioral Health Case Manager II

Director

• Leads strategy and implementation of new products or product changes/enhancements for all Commercial segments and regions
• Work with and process large, complex datasets, both structured and unstructured, by handling tasks such as ETL/ELT, metadata extraction, dataset registry, cohort development, and data enrichment/merging to facilitate comprehensive analysis
• Collaborate with partners to analyze data usage and technology solutions, design and guide the effective use of products, and develop high-quality assets that enhance product development, enablement functions, and differentiate our offerings in the market
• Partner with product and engineering teams to package methods for operational use, and enhance products with advanced computational techniques and an expanded analytics tech stack, including LLM co-piloting, natural language prompting, and no/low-code integrations
• Monitors product performance and the competitive environment to ensure products meet competitive and legislative needs
• Adheres to product development policies and processes to guide product development
• Responsible for innovation and development of products for both new and existing markets
• Coordinates presentation, communication and implementation of all phases of product development
• Ensures all products are compliant with regulatory directives and state/federal laws and policies
• Serves as a product expert and a relationship manager to the core clients
• Collaborates with matrix partners across the company to deliver product solutions in a timely and effective manner
• Monitor competitive, regulatory, economic and other environment to gauge product impacts or opportunities

Product Development Director – Data Platforms

• Analyze complex business problems and analyze healthcare, business system, and financial data
• Identify patterns of suspicious activity, outliers, anomalies and other risk issues
• Apply strong knowledge of SQL for data extraction, quantification, analysis, reporting, and ETL
• Develop complex databases, queries, and reports
• Utilize multiple corporate data repositories including SQL Server and Oracle databases
• Function as a liaison between departments to analyze data and communicate findings

Senior Investigative Analyst

Consultant

• Supports Employee Assistance Program (EAP) service department by responding to initial customer contacts and request for services
• assesses situation, determines appropriate course of action
• Provides telephone and/or on-site support for crisis intervention, assessment, short term problem resolution and referral to appropriate provider(s)
• Manages Critical Incident Stress Debriefing requests
• Assesses members and assists them in accessing behavioral healthcare benefits available under their health plan
• Applies specialized knowledge in substance abuse, domestic abuse, grief counseling, workplace problems, and management consultation
• Provides employer consultation to supervisors, managers, and Human Resources of the EAP contracted organization
• Manages shared mailbox used by clients and external vendors

Behavioral Health EAP Consultant II

• 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.
• Performs duties telephonically such as at hospitals for discharge planning.
• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and family’s 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

Vice President

• Identifying, evaluating, and executing inorganic growth opportunities
• Leading mergers, acquisitions, divestitures, and strategic partnerships
• Partnering closely with Finance, Strategy, Legal, Operations, and business leaders
• Conducting end-to-end M&A execution
• Developing and overseeing financial models
• Supporting integration and value realization post-transaction
• Building trusted relationships with business unit leaders
• Improving M&A processes leveraging data, analytics, and emerging AI tools
• Leading, developing, and empowering a high-performing corporate development team

Staff VP, Corporate Development – M&A

• Managing psychiatric and substance abuse treatment health benefits through telephonic or written review
• Assessing member needs to ensure access to necessary quality behavioral healthcare
• Referring cases to Peer Reviewers as appropriate
• Performing psychiatric and substance abuse assessments, coordination, implementation, case planning, monitoring, and evaluation

Behavioral Health Care Manager

General Counsel

• supporting complex enterprise-wide sourcing and supply agreements
• focus on managed care procurement vendor agreements (Medicare, Medicaid)
• advising on complex legal issues related to managed care contracting
• developing and negotiating a broad spectrum of complex vendor and supply technology transaction types
• working successfully with core partners in Procurement, Health Plan, and other business organizations
• liaising with business unit legal colleagues and groups such as Information Security, Privacy, Tax, Finance, and Corporate Development
• providing advice and assistance to management and executives
• handling complex projects with broad organizational impact and moderate to high level of risk
• supervising outside counsel and managing associated budgets

Associate General Counsel – Commercial Vendor Transactions

Bilingual

• Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.
• Analyzes problems and provides information/solutions.
• Operates a PC/image station to obtain and extract information;
• Thoroughly documents inquiry outcomes for accurate tracking and analysis.
• Develops and maintains positive customer relations and coordinates with various functions within the company.
• Performs basic job functions with help from co-workers, specialists and managers on non-basic issues.
• Researches and analyzes data to address operational challenges and customer service issues.

Cust Care Rep I – Bilingual

Data Engineer

• Provides guidance on data architecture matters
• Ensures that industry-accepted data architecture principles, standards, guidelines and concepts are integrated
• Implements programs to achieve competitive advantage
• Oversees enterprise-wide modeling efforts
• Ensures cross-team collaborations are in place to support an integrated approach to sharing across technical disciplines
• Develops a formal portfolio of data architecture services