Elevance Health

Manager

• Responsible for 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 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

Software Engineer

• Maintains active relationships with customers to determine business requirements
• Owns the change request process and may coordinate with other teams as necessary
• Develops and owns list of final enhancements
• Develops and defines Epic Reporting structure and objectives
• Prepares technical and/or functional specifications from which programs will be written
• Performs technical design reviews and code reviews
• Ensures unit test is completed and meets the test plan requirements
• Coordinates on-call support and ensures effective monitoring of system
• Mentors others and may lead multiple or small to medium sized projects

Developer Advisor – Epic Clarity, Caboodle Admin

Director

• Serves as a trusted advisor and thought partner to the Senior Leadership Team (SLT)
• Champions the integration of human-centered design and digital transformation principles into Elevance Health’s workforce strategy
• Partners with business and HR leaders to activate organizational strategies, including structure, governance, and process redesign
• Leverages data analytics, dashboards, and portfolio tracking tools to generate actionable insights into organizational health
• Designs and builds custom tools and AI-powered knowledge solutions to enhance engagement and change strategies
• Provides expert consultation to business leaders to enhance team effectiveness and operational performance
• Influences a team of COE partners, executive leadership, project teams and HRBPs

Organizational Design & Effectiveness Director – Enterprise Center of Excellence

Security Engineer

• Own and evolve automated penetration testing tools and processes
• Lead development and execution of risk assessment methodologies
• Define testing strategy, scope, and coverage aligned to business risk
• Lead analysis of attack paths and systemic vulnerabilities
• Develop security incident response plans and strategies

Senior Cybersecurity Advisor – Offensive Security, Exposure Management

Bilingual

• Verifies member information and inputs data for the pharmacists
• Educates members on pharmacy based rules related to prescriptions and medication resources or assistance programs
• Processes prior authorization requests from physician’s offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization determinations
• Provides resolution to grievances and appeals issues
• Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits
• Generates reports relating to rebates, physician utilization, Beers Criteria, Reliance members, and other ad hoc reports
• Maintains record keeping of prior authorizations, rebates, and monthly reports

Pharmacy Technician II – Bilingual

• Operate and evolve continuous penetration testing capabilities to uncover exploitable attack paths
• Simulate adversary behavior and drive measurable risk reduction
• Partner closely with engineering, cloud, and security teams to turn findings into action and improve overall security posture
• Provide trouble resolution on complex problems and lead implementations for system and network security technologies
• Optimize continuous penetration testing across on-prem, cloud, and hybrid environments
• Coordinate and prepare the reporting of data security events and incidents
• Analyze attack paths and prioritize risk based on exploitability and impact
• Track risk reduction and report on trends and outcomes
• Identify control gaps and recommend and implement improvements

Senior Offensive Security, Exposure Management Analyst

Pharmacist

• Research and synthesize detailed clinical data related to pharmaceuticals
• Serves as a clinical resource to other pharmacists on areas such as formulary, utilization management edits, DURs and coordinates with operations team to code programs to meet intent
• Leads pharmacy claims adjudication configuration by translating formulary and utilization management requirements into claims processing rules/edits
• Interprets and operationalizes Medicaid/state requirements by creating clear clinical criteria and configuration documentation for PA and claims systems; provides independent oversight to ensure consistent, compliant program setup

Clinical Pharmacist

Consultant

• managing and supporting change management aligned with transformational business initiatives with various stakeholders enterprise wide
• embedding user adoption through change management practices into business strategies to achieve the desired business outcomes
• applies structured change management methodology to facilitate change and promote adoption
• identifies the need for agility and modifies approach to meet the needs of the stakeholders
• leading, coordinating and providing visibility into engagement, communications, and training efforts for all enterprise transformation initiatives
• provides strategic consultation and execution to support adoption of change initiatives
• prepares stakeholders by assessing the magnitude and complexity of change with the organization’s readiness and associated risks
• conducts thorough methodological analysis of change impacts and identifies key stakeholders impacted by the change
• conducts an environment scan to identify potential challenges and areas of resistance for stakeholders
• creates and delivers engagement and communications plans to ensure all stakeholders are fully aware of impending changes
• solicits feedback from stakeholders to determine and measure the success of change management activities

Enterprise Change Management Consultant

Operations

• Lead digital transformation initiatives that improve claims operations and overall service delivery
• Partner with leaders across the organization to implement strategic plans and shared goals
• Manage the resolution of intra-organizational issues
• Execute objectives of the company and the blended Digital Ops organization
• Ensure compliance with state and federal regulations
• Oversee strategic planning, budget development, and management
• Ensure disaster recovery and business continuity plans are in place
• Provide operational guidance and system solutions
• Develop a strong team through training and effective organizational practices

Director II, Claims Operations Transformation

Therapist

• The Therapy Services Reviewer is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy) were medically necessary and filed appropriately.
• Follows the system guidelines that makes decisions on approval for care for a patient.
• Processes system generated decisions for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction.
• Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements.
• Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary.
• Acts as a resource for internal and external customers.
• May participate in intradepartmental teams, projects, and initiatives.
• Maintains quality and productivity standards and ensures reviews are conducted within required timeframes.

Therapy Services Reviewer

• Provides primary and urgent health care via telephone and tele video modalities
• Collaborates with company physicians, the patient’s other physicians and providers, and their family members to develop complex plans of care
• Gathers history and physical exam and diagnostics as needed
• Develops and implements treatment plans based on patient’s goals of care and current conditions
• Identifies and closes gaps in care
• Maintains patient medical records and documentation consistent with state regulations and company standards and policy
• Participates in continuing education as required by state and certifying body
• Prescribes medication as permitted by state prescribing authority

Bilingual Advanced Practice Provider – English, Mandarin

• Provides primary and urgent health care via telephone and tele video modalities
• Collaborates with company physicians and other healthcare professionals
• Develops and implements clinical plans of care for adult patients
• Gathers patient history and physical exam
• Identifies and closes gaps in care
• Educates patients and families about medication and health
• Maintains patient medical records and documentation

Bilingual Advanced Practice Provider – English/Spanish

• The Telephonic Nurse Case Manager I is responsible for 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 or on-site such as at hospitals for discharge planning.
• Ensures members understand benefits and assist in access of 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 through actions based on assessments including providing education, 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 other health professionals on the development of care management treatment plans.
• Assists in problem solving for members and providers related to access to care, vendors, claims or service issues.

Nurse Case Manager I – Oncology

• planning, directing, and controlling multiple teams of resources and initiatives
• planning and execution of company-wide efforts and goals
• manages budgetary constraints
• interfaces with key technology solution vendors
• develops application technology plans and strategies
• managing disaster recovery and business continuity plan
• identifies and resolves hurdles for assigned areas/groups according to established deadlines
• partners with customers in order to understand new product enhancements or features being requested
• hires, trains, coaches, counsels, and evaluates performance of direct reports
• plans and executes annual projects while maintaining profit and loss (P&L) responsibility

Director II, Engineering

• Responsible for end-to-end program, project, and product delivery
• Manages large-scale FEP initiatives across business units
• Acts as a dual Project Manager for product strategy execution
• Partners with product and delivery teams to drive strategic product roadmaps
• Determines project and program scope
• Manages multiple concurrent large-scale initiatives
• Develops and maintains project governance artifacts
• Coordinates and manages vendor and partner engagements
• Defines quality gates for each project methodology phase
• Influences at all levels of the organization
• Coaches and mentors project team members