Jobs at Elevance Health

Serve as a strategic business and systems partner to translate business needs into requirements, lead cross-functional workstreams, analyze processes and data, define testing strategies (UAT), support implementations, and improve system performance across claims, provider, and member functions.

Perform nursing case management for members with complex/chronic needs: assess, develop, implement, coordinate, monitor, and evaluate individualized care plans; facilitate authorizations/referrals; coordinate resources; liaise with medical directors and providers; help resolve provider/claims issues and negotiate reimbursement rates.

Field-based sales role executing a regional strategy to drive adoption of BioPlus Specialty Pharmacy across specialty therapy areas. Build and maintain provider and stakeholder relationships, document activity and performance in Salesforce/databases, maintain call cycles, provide clinical and reimbursement support, attend meetings and conferences, and travel frequently within the Northeast territory.

Serve as primary client lead for Nevada's 988 Crisis Call Response system, overseeing statewide behavioral health operations. Manage account strategy, performance metrics, client retention, upsell/rebids, and stakeholder engagement across call centers, mobile crisis, stabilization, and follow-up care. Lead client communications, coach account managers, and ensure contract and KPI alignment while supporting growth and P&L objectives.

Field-based sales role responsible for driving adoption of BioPlus Specialty Pharmacy across a regional territory. Build and maintain provider and stakeholder relationships, use Salesforce and databases to manage accounts and call cycles, support specialty pharmacy education and reimbursement processes, and travel frequently to meet business objectives.

Coordinate and oversee clinical nurse reviewers and support staff, manage complex medical review cases, interpret medical policy and Medicare criteria, support process improvement and serve as a departmental resource and liaison.

Manage and execute statewide ombudsman strategy for the NC Children and Families Specialty Plan. Coordinate services with community and advocacy organizations, resolve member/provider disputes, recommend policy/process changes, report issues to leadership, develop and manage external client-facing programs and budgets, train stakeholders, measure program success, and support care delivery improvements across regions.

Conduct pre- and post-payment audits of complex, high-dollar insurance claims across lines of business. Verify eligibility, coding, pricing, pre-authorization, and medical necessity; document findings, identify processing errors and improvement opportunities, refer overpayments, mentor audit staff, and serve as unit subject matter expert.

Serve as an internal HR consultant solving complex workforce challenges via sprint-based projects. Lead org design, workforce analytics, talent optimization, change enablement, and agile sprint execution. Mentor junior staff, create scalable solutions and playbooks, diagnose problems through stakeholder interviews and data, and co-create evidence-based HR solutions with business partners.

Lead month-end reporting, forecasting, annual and long-term planning, and ad-hoc financial analyses. Serve as liaison between finance leadership and business units, support commercialization and growth initiatives, and manage cross-functional strategic projects to drive financial decision-making.

Provide field-based and telephonic case management for special populations (e.g., foster care). Conduct assessments, create and modify integrated care plans, coordinate physical/behavioral health and social determinants resources, work with state agencies, perform patient education and follow-up, and build culturally responsive partnerships with members and families.

Assemble and maintain billing documentation and database, reconcile discrepancies, post to sub-ledgers, support first-line collections, process payments (EFT/ERA, credit card, lockbox), and communicate billing information to internal and external stakeholders while handling complex billing issues independently.

Analyze and report on business metrics by creating and maintaining databases, developing periodic and ad hoc reports, identifying performance anomalies, and recommending actions to support decision-making.

Perform clinical and claims analysis to identify and investigate potential fraud and abuse. Conduct retrospective claims and medical record reviews, collaborate with SIU and internal teams, recommend interventions, and research healthcare issues to prevent loss.

Performs medical necessity screenings and preauthorization reviews for diagnostic imaging, out-of-network and appropriateness-of-treatment requests. Communicates decisions to providers, follows up for additional clinical information, documents per department standards, and partners with senior colleagues on complex cases.

Serve as a senior business and systems partner for Medicaid encounter systems, translating operational issues into requirements, analyzing encounter data, driving remediation, supporting reconciliations, building reporting/analytics, and coordinating cross-functional implementation, testing, and governance to improve compliance, data integrity, and financial outcomes.

Design, develop, and implement business-aligned learning solutions. Conduct needs analysis, collaborate with stakeholders and cross-functional teams, create and maintain content, follow approved tools/processes, participate in quality reviews, and contribute to L&D communities of practice.

Process and distribute incoming, interoffice, and outgoing mail. Pick up and deliver internal mail, sort by organization/location/individual, prepare packages for external pickup, and respond to customer inquiries regarding mail services.

Serve as the liaison between HR and IT to analyze, design, develop, and maintain HRIS/Workday solutions, translate complex business needs into system requirements, support integrations and uptime, lead functional recruiting technology projects, collaborate on design and testing, and provide user support. Role requires hybrid work, occasional weekend availability, and CST/EST hours.

Field-based provider relations role managing a defined provider portfolio: build relationships, resolve provider issues and appeals, coordinate provider education and training, communicate policy/reimbursement changes, support provider satisfaction and network retention, and travel to provider sites in NW Iowa.