Elevance Health

Account Manager

• RVP is responsible to manage and grow a portfolio of customer relationships
• P/L ownership, set the strategy and drive the execution to surpass customer contractual obligation
• expand share of wallet and develop strong strategic stakeholder relationships within markets served
• Partner internally with shared service teams for a seamless customer experience
• Team Scope Leader will have 7 Direct reports
• Drive P/L health, contractual compliance and customer satisfaction
• Develop deep knowledge of client needs and the local market drivers in order to build and maintain robust data-driven account plans on a yearly planning cycle
• Serve as the go-to-expert on client account, with the ability to interface with key internal and external personnel on all issues
• Partners with Sales and Government Relations to provide leadership and strategic direction to identify upselling opportunities and ensure profitable growth
• Develops and motivates staff to achieve common goals
• Hires, trains, coaches, counsels, and evaluates performance of direct reports

RVP Sales Account Management – West Market Lead

Manager

• Leads and manages multiple cost of care initiatives enterprise wide (e.g. local, within each state, across business segments and at the enterprise level) and drives their execution.
• Understands, predicts and implements measures to control healthcare costs and to make healthcare more affordable for our customers.
• Develops, manages, oversees, and executes new and innovative initiatives to manage rising costs and enhance the company's market competitiveness.
• Identifies and develops best practices and cost of care improvement processes around physician, hospital and ancillary network contract negotiation strategies, utilization management efforts, new products, annual benefit design participation, and financial operations.
• Oversee the identification of potential cost of care savings opportunities through complex analytics via partnering with the cost of care analytics team, to develop action plans, benefits and risk assessments and overseeing and partnering with the actuarial team to develop and ensure accurate savings quantification.
• Champions cost of care initiatives, negotiates for human capital resources, and partners with care management, claims, IT, and business partners.
• Manages and presents cost of care projects to senior leadership including State Plan Presidents.
• Serves on local and enterprise committees.
• Plans, leads and oversees cost of care planning meetings and tracks and reports on cost of care projects.

Cost of Care Manager

• work with Virginia dual membership members
• meeting with members in person as per contractual requirements
• performing case management telephonically and/or by home visits
• using appropriate screening criteria to assess member needs
• conducting assessments to identify individual needs and developing a care plan
• monitoring and evaluating effectiveness of care plans
• supporting member access to appropriate quality and cost-effective care
• coordinating with internal and external resources

Behavioral Health Case Manager I

Consultant

• May lead teams of analysts assigned to complex projects
• Determines specific business application software requirements to address complex and varied business needs
• Analyzes and designs solutions to address complex and varied business needs
• Consults with business partners concerning application and implementation of technology
• Lead client consultations to identify and resolve payment integrity issues
• Analyze complex claim scenarios and business rules to uncover overpayments
• Guide cross-functional teams through the development and implementation of recovery strategies
• Design business solutions to address diverse client requirements
• Partner with query developers to refine logic based on client data and operational feedback
• Facilitate internal and external meetings, ensuring alignment across stakeholders
• Document findings, track projects, and manage timelines to successful delivery

Business Consultant – Carelon Payment Integrity

Financial Planning and Analysis

• Provides technical database analysis leadership
• Sets strategic direction of projects related to medium to high complexity databases and/or related analysis and reporting
• Manages database processes, related analysis and reporting
• Reviews and approves changes to database coding
• Prepares and reviews monthly and quarterly financial reports and complex analysis related to these databases
• Designs research plans for data gathering and analysis; manages projects to deadlines
• Initiates and resolves complex database issues requiring technical expertise
• Analyzes, reports, and develops recommendations on data related to complex and varied business metrics
• Develops appropriate diagnostic analysis and reporting and/or tracking data that will translate business requirements into usable decision support tools
• Leads a team of associates, mentors, trains, and coaches lower level analysts

Senior Financial Accounting Database Analyst

• Provides analytical support to the Cost of Care and/or Provider Contracting organizations
• Focuses efforts on lowering claims costs
• Improves the quality of care
• Increases member and provider network satisfaction
• Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues
• Works on large scale initiatives with high dollar cost savings opportunities
• Works on complex enterprise-wide initiatives and acts as project lead
• Uses analytic tools to track both health risks and compliance
• Supports the contract negotiation process
• Performs sophisticated retrospective data analytics
• Builds new and modifies existing complex models to create predictive impact decision making tools
• Performs healthcare cost analysis to identify strategies to control costs
• Projects cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis
• Performs modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic
• Researches the financial profitability/stability and competitive environment of providers to determine impact of proposed rates
• Projects different cost of savings targets based upon various analytics
• Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures
• Recommends policy changes and claims system changes to pursue cost savings
• Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable
• Recommends standardized practices to optimize cost of care
• Educates provider contractors on contracting analytics from a financial impact perspective
• Recommends alternative contract language and may go on-site to provider premises during contract negotiations
• Participates on project team involved with enterprise-wide initiatives
• Acts as a source of direction, training and guidance for less experienced staff

Provider Contract, Cost of Care Consultant

Account Executive

• Develop and maintain relationships with external clients and prospects
• Reach internal health plan penetration goals through consultative skills
• Execute strategic sales and tactical plans by consulting with key decision makers and operational stakeholders
• Provide ongoing support to regional decision makers
• Support PBM field sales team during RFP processes

Pharmacy Account Director – Commercial Employer Group Consultant

Director

• Coordinates the relationship of a business unit with internal and external State partners to ensure growth and compliance
• Monitors related legislation and advises senior management relative to compliance
• Researches new ventures and prospective revenue expansion opportunities
• Assists in creating HealthPlan strategic and annual plans
• Travels to worksite and other locations as necessary

LTSS Strategy – Program Development Director

• Engage collaboratively with key stakeholders—including families, foster parents, and service teams—to craft and sustain individualized treatment plans.
• Conduct assessments to identify individual needs.
• Develop 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 member and incorporates that into care planning.
• Works closely with various state agencies.
• Maintains knowledge of the system of care philosophy; a spectrum of effective, community-based services and supports 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, in order 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.

IDD Specialty Care Manager, Foster Care

• Manage psychiatric and substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review
• Use appropriate screening criteria and clinical judgment to assess member needs
• Refer cases to Peer Reviewers as needed
• Perform assessment coordination, case planning, monitoring, and evaluation to optimize member health benefits

Behavioral Health Care Manager, I

Software Engineer

• Undertakes complex assignments requiring additional specialized technical knowledge.
• Develops very complex and varied strategic report applications from a Data Warehouse.
• Establishes and communicates common goal and direction for team.
• Establishes and maintains advanced knowledge of data warehouse database design, data definitions, system capabilities, and data integrity issues.
• Acts as a source of direction, training, and guidance for less experienced staff.
• Monitors project schedules and costs for own and other projects.
• Develops and supports very complex Data Warehouse-related applications for business areas requiring design and implementation of database tables.
• Conducts training on use of applications developed.
• Focuses on spending time thinking about programming and how it would be used to design solutions.

Senior Business Information Developer Consultant

• develops Carelon Behavioral Health autism solution strategy in partnership with product, clinical, network, and other core stakeholders
• provides comprehensive financial, analytic, and business insight across Carelon Behavioral Health autism solution
• conducts analysis of market trends and consumer needs to guide strategic direction and assess the value of initiatives
• collaborates with product teams to advance risk products through all phases of the product lifecycle management process
• investigates and manages internal and external issues, to include provider issues, clinical issues, and other inquiries
• may provide leadership and/or oversight of projects, project teams and/or external consultants

General Manager – Emerging Behavioral Health

Business Analyst

• Identifying, analyzing, and validating overpayment recovery opportunities
• Translating moderately complex and varied business needs into business cases or business requirements document (BRD)
• Creating data mining queries that will contribute to cost of care savings
• Migration of datamining concepts and ensuring new systems meet department needs
• Auditing claims payment to identify overpayment scenarios
• Determining specific business application software requirements to address complex business needs
• Developing project plans and identifying and coordinating resources
• Working with programming staff to ensure requirements will be incorporated into system design and testing
• Acting as a resource to users of the software to address questions/issues
• Providing direction and guidance to team members and serves as an expert for the team.

Business Analyst III

• Provides strategic planning and account management for large accounts
• Directs and manages the administration of contractual requirements and obligations
• Manages the new and renewal implementation process for accounts
• Interfaces with operations to ensure smooth delivery of services
• Maintains ongoing account relationships at multiple levels throughout the customers' organizations
• Makes recommendations for improvements to meet customers' expectations
• Provides both on-site and off-site customer service, including interpreting plan design and resolving claims, benefit, and enrollment issues
• Coordinates open enrollment meetings, renewal process, and training sessions
• Makes routine account visits

Account Service Manager

• Support our Finance - AI team by identifying and implementing new solutions in automation and AI within our broader Finance organization
• Interact with business leaders in developing projects and strategic initiatives to further fluency with and access to AI within the finance organization
• Analyze large-scale and complex data sets from reports to develop strategic recommendations for business improvement
• Collaborate with team members to prototype AI solutions for finance professionals
• Collect, analyze, and clearly document existing business processes to ensure a thorough understanding of current workflows
• Utilize the core financial analytics skill set to develop financial profiles for automation implementation
• Communicate and collaborate with internal and external business leaders