Jobs at Elevance Health

Manages multi-year, external client-facing programs, including development, approval, implementation, compliance, budgets, objectives, client relationships, training, success metrics, and periodic assessments. Researches industry practices and trends while partnering with corporate and regional business areas to address program issues and support business strategies.

Oversees patient check-in, registration, and checkout; verifies charts and demographics; addresses patient questions and complaints; routes issues; analyzes daily administrative operations; assists with Medic user issues; ensures cash controls and policy compliance; provides coverage PRN for sick call-offs, PTO, and high census days.

Leads architecture, development, testing, deployment, and support of enterprise AI-enabled applications. Designs agentic AI solutions, integrations, evaluation frameworks, prompts, guardrails, and secure API access. Drives AI adoption across engineering teams, performs technical and code reviews, manages requirements and change requests, oversees monitoring and on-call support, and mentors engineers. Partners with business and technical stakeholders on architecture, strategy, reliability, and long-term technology direction.

Analyzes complex business data, maintains databases, develops performance and ad hoc reports, identifies anomalies, and recommends improvements. Supports SQL Server environments and backend database objects, translating business requirements into reliable technical solutions. The role also troubleshoots data quality and production issues, considers downstream reporting impacts, and provides technical guidance to junior staff.

Grows new and existing specialty pharmacy accounts across Oklahoma and nearby states, achieves territory sales targets, develops healthcare and pharmaceutical relationships, identifies referral opportunities, maintains account call cycles, supports specialty pharmacy initiatives, and communicates competitive and market intelligence to leadership. The field-based role requires up to 60% travel and strong understanding of specialty pharmacy and relevant therapeutic areas.

Generates and qualifies sales leads through outbound email, phone, and social outreach. Conducts market research, nurtures prospects, schedules discovery meetings, analyzes campaign performance, and reports pipeline results. The role optimizes lead-generation processes, maintains CRM data quality, collaborates cross-functionally on solutions and launches, and ensures activities follow applicable regulations and best practices.

Manages complex and chronic care cases for health plan members by assessing needs, developing and coordinating care plans, arranging authorizations and referrals, monitoring outcomes, and collaborating with providers, Medical Directors, and Physician Advisors. The role also supports discharge planning, resolves provider and claims issues, negotiates reimbursement rates, and contributes to care management policies. Work is primarily virtual or telephonic, with occasional on-site hospital duties and required multi-state licensure.

Support capitation configuration and policy implementation for health plans. Translate business needs into application requirements, test implementations, analyze provider payments/contracts, perform data and trend analysis, and collaborate with cross-functional teams to resolve provider questions and system issues.

Responds to customer questions about retail and mail-order prescriptions by phone and written correspondence. Coordinates with internal and external stakeholders, researches requests, resolves issues promptly, and guides customers through available options, technology, and resources. The role requires strong communication, problem-solving, analytical, and interpersonal skills in a primarily virtual specialty pharmacy customer-service environment.

Oversee patient check-in, registration, and checkout processes at an onsite infusion clinic. Verify charts, update demographics and eligibility, maintain current forms, address patient and family concerns, route questions and complaints, analyze administrative operations and resource utilization, assist with Medic system issues, and ensure cash-control policies are followed.

Leads enterprise workflow modernization and architecture while designing scalable AI solutions, distributed systems, integrations, and digital products. Establishes technical standards, governance, responsible AI practices, and AI-enabled SDLC improvements. Partners with product, design, architecture, security, operations, and business teams to deliver secure, resilient workflow experiences. Provides hands-on technical leadership, mentorship, modernization strategy, and guidance on enterprise AI investments.

Leads enterprise cloud and infrastructure strategy, delivery, adoption, portfolio governance, customer success, FinOps, financial management, service performance, and operational excellence. Oversees cloud modernization, capacity planning, executive reporting, governance, strategic vendors, and cross-functional alignment across technology, finance, security, architecture, engineering, and business teams. Builds and develops a 30-person organization while driving accountability, reliability, cost optimization, and measurable business outcomes.

Lead and manage utilization and care management programs for physical and behavioral health populations. Ensure compliance, develop medical and case management policies, oversee utilization review, support quality initiatives (HEDIS/NCQA), liaise with state regulators, drive cost-of-care strategies, and manage clinical operations and stakeholder partnerships.

Coordinates complex business impact analyses, consolidates forecast and month-end results, prepares executive reporting, and develops solutions for business needs. Collaborates with business and technical teams on product enhancements, optimizes reporting processes, supports internal audits, and serves as a data expert for selected applications. The role requires advanced data analysis, visualization, problem-solving, presentation, and stakeholder leadership skills in a hybrid healthcare business environment.

Develop and improve corporate tax data platforms, decision-support systems, data models, reporting applications, and data warehouse solutions. Design database tables, analyze tax data sources and flows, address data integrity issues, and program tax systems. Coordinate project activities, monitor schedules and costs, and train users on developed applications. The role requires strong programming and tax system design expertise, with preferred experience in Microsoft Fabric, Python, SQL, Microsoft BI tools, Oracle platforms, and tax data systems.

Coordinates utilization management cases for precertification and prior authorization, verifies benefits and eligibility, enters referrals, conducts clinical screening, and escalates cases for nurse review. Handles calls and written inquiries from members, providers, and internal teams while managing multiple electronic queues and maintaining accurate, timely service. Provides authorized sessions, resolves customer issues, and supports payer operations in a virtual, fast-paced environment.

Leads enterprise AI adoption by evaluating vendors, models, platforms, and emerging technologies; designing reusable agentic frameworks and reference architectures; developing prototypes and proofs of concept; and enabling scalable, secure AI solutions. Partners with business, engineering, security, legal, compliance, and procurement teams to define adoption standards, evaluate tradeoffs, and guide AI investments across cloud, distributed systems, APIs, microservices, and DevOps environments.

Maintains and validates provider information across claims and provider databases. Synchronizes data across multiple claims systems, applies business rules, and ensures provider records meet customer, contracting, network management, credentialing, and system requirements.

Provides telephonic care management for consumers with complex and chronic conditions, especially oncology and REMS cases. Conducts clinical assessments, develops and monitors individualized care plans, evaluates treatment appropriateness, and coordinates with physicians, pharmacists, and other providers to improve outcomes and continuity of care. The hybrid role requires an active unrestricted RN license and supports services across multiple states when applicable.

Provides telephonic and on-site case management for members with complex and chronic conditions. Assesses needs, develops and coordinates care plans, facilitates authorizations and referrals, monitors outcomes, coordinates internal and external resources, collaborates with medical directors, and resolves provider, claims, and service issues.