Elevance Health

Role Description Bilingual Nurse Practitioner 100% Virtual, CareBridge $5,000 Sign-on Bonus Seeking Bilingual Nurse Practitioner candidates that have an active, unrestricted Nurse Practitioner license in either of the following states: Texas, Kansas, or Iowa AND must have an active RN Compact license. This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Shift: Monday-Friday, 8:00am-5:00pm and rotating on-call. The Bilingual Advanced Practice Provider, Nurse Practitioner is responsible for collaborating with company providers and their family members to develop complex plans of care in accordance with the patient’s health status and overall goals and values. Provides clinical and non-clinical support to patients presenting with acute care needs virtually. How you will make an impact: - Provides urgent health care via telephone and tele video modalities to patients who receive home and community-based services through state Medicaid programs, dual eligible members and other membership as assigned by our MCO partners. - Develops and implements clinical plans of care for adult patients facing chronic and complex conditions (e.g., co-morbid medical and mental health diagnoses, limited personal resources, chronic medical conditions). - Gathers history and physical exam and diagnostics as needed, and then develops and implements treatment plans given the patient’s goals of care and current conditions. - Identifies and closes gaps in care. - Meets the patient’s and family’s physical and psychosocial needs with support and input from the company’s inter-disciplinary team. - Educates patients and families about medication usage, side effects, illness progression, diet and nutrition, medical adherence and crisis anticipation and prevention. - Maintains contact with other clinical team members and other medical providers to coordinate optimal care and resources for the patient and his or her family in a timely basis and consistent with state regulations and company health standards and policy. - Maintains patient medical records and medical 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. Qualifications - Requires an MS in Nursing. - Requires an active national NP certification. - Requires valid, current, active and unrestricted Family or Adult Nurse Practitioner (NP) license in either one of the following states: Texas, Kansas, or Iowa. - Active, unrestricted RN Compact license is required. - Bilingual or multi-language skills required. - Requires 2 years+ of experience in managing complex care cases. - Experience working with Electronic Medical Records (EMR). Requirements - Medicaid number. - Possession of DEA registration or eligibility. - Experience in managing complex care cases for developmental disabilities and chronically ill patients. Benefits - Market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs. - Medical, dental, vision, short and long term disability benefits. - 401(k) + match. - Stock purchase plan. - Life insurance. - Wellness programs and financial education resources.

Nurse Case Manager I Location: - WA-SEATTLE, 705 5TH AVE S, STE 300, United States of America - CA-WALNUT CREEK, 2121 N CALIFORNIA BLVD, 7TH FL - FL-MIAMI, 11430 NW 20TH ST, STE 200 & 300 - FL-TAMPA, 5411 SKYCENTER DR, STE 700 & 800 - IL-CHICAGO, 233 S WACKER DR, STE 3700 - IN-INDIANAPOLIS, 220 VIRGINIA AVE - MO-ST. LOUIS, 100 S 4TH ST - NV-LAS VEGAS, 3634 S MARYLAND PKWY - OH-CINCINNATI, 3075 VANDERCAR WAY - TX-GRAND PRAIRIE, 2505 N HWY 360, STE 200 & 300 Remote Full-time Nurse Case Manager I The Nurse Case Manager I will be 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. Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. - Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. Schedule: Monday - Friday, 8AM - 5PM PST. The candidate can sit anywhere as long as there are near an office but must be willing to work West Coast hours. How you will make an impact: - 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. Minimum Requirements: - Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. - Current and active RN license required in applicable state(s). - Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities and Experiences: - Certification as a Case Manager is preferred. - Previous MCO or Hospital Case Management experience is preferred. - Telephonic case management experience preferred. For URAC accredited areas the following applies: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager and a BS in a health or human services related field preferred. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $70,560 to $100,800. Location(s): California, Illinois, Nevada and Washington State. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Role Description Join Carelon's growing Behavioral Health Community Connect team supporting the Health Stress Program across Washington and Nevada Medicaid markets. In this virtual role, you'll provide whole-person care by conducting behavioral health assessments, developing care plans, coordinating services, and connecting members with community resources to improve health outcomes. The Behavioral Health Case Manager II is responsible for performing case management telephonically within the scope of licensure for members with behavioral health and substance use or substance use disorder needs. Subject matter expert in targeted clinical areas of expertise such as Alcohol / Drug use, Autism Spectrum Disorders (ASD) etc. with an understanding of SDoH needs and the impact on whole health. Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. How you will make an impact: - 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 Managers. - Participates in cross-functional teams projects and initiatives. Qualifications - Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing, and minimum of 3 years of clinical experience in social work counseling with broad range of experience with complex psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience which would provide an equivalent background. - Current active unrestricted license such as RN, LCSW, LPC (as allowed by applicable state laws) LMFT, LMSW (as allowed by applicable state laws) or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States required. - Previous experience in case management and telephonic and/or in person coaching with members with a broad range of complex psychiatric/substance abuse and/or medical disorders. - Managed care experience required. Requirements - Active RN license is highly preferred. - Licensure for Washington and/or Nevada is necessary, multi-state preferred. - Behavioral Health Case Management and Managed Care experience preferred. - Medicaid and hospital/inpatient case management experience. - Experience with high-risk, high-utilization, housing insecure, or food insecure populations preferred. - Knowledge of social determinants of health and whole person care. - Community resource coordination and telephonic care management. - Health coaching and motivational interviewing skills. - Strong clinical assessment, care planning, and interdisciplinary collaboration. - Excellent communication skills with the ability to work independently in a virtual environment. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements).

Role Description Pharmacy Technician II Hours: 12pm – 8:30pm eastern time zone This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. The Clinical Pharmacy Care Center (CPCC) is a clinical pharmacy call center that services Medicare, Medicaid, and the Commercial member populations. The members we reach out to have been identified as having gaps in care. Our goal is to close those gaps through education and assistance. - Verifies member information and inputs data for the pharmacists. - Educates members about prescriptions and medication resources or assistance programs. - Educates members on medication adherence-related topics to align closely with STARs Ratings and HEDIS quality measures. - Assists members with scheduling their preventive test/screenings and medication resources or assistance programs. - Makes outreach to members or providers to close care gaps and improve outcomes. Qualifications - Requires an active, professional license, if required by state law, State Pharmacy Technician Certification or National Certification based on applicable state(s) requirements, to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States. - Requires H.S. diploma or equivalent and minimum of 2 years of pharmacy experience; or any combination of education and experience, which would provide an equivalent background. Requirements - Experience communicating with and supporting Medicaid members preferred. - Call center experience with high call volumes preferred. - Experience in discussing medication adherence preferred. - Proficient in computer systems and multitasking preferred. - Patient care experience preferred. - Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Benefits - Merit increases - Paid holidays - Paid Time Off - Incentive bonus programs (unless covered by a collective bargaining agreement) - Medical, dental, vision benefits - Short and long term disability benefits - 401(k) + match - Stock purchase plan - Life insurance - Wellness programs - Financial education resources

Role Description The Diagnosis Related Group Clinical Validation Auditor-RN is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. - Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. - Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions. - Utilizes audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters. - Maintains accuracy and quality standards as established by audit management. - Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs). - Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations. Qualifications - Requires current, active, unrestricted Registered Nurse license in applicable state(s). - Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement. - Requires a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background. Requirements - One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. - Experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement experience preferred. - Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements).

• Maintaining patient files • Responding to requests for medical records • Performing clerical activities in support of the medical records department • Protecting the security and integrity of medical records • Ensuring patient confidentiality is maintained • Maintaining patient files and retrieving files for scheduled appointments • Processing letters and reports related to medical records

• Perform care management telephonically within the scope of licensure for members with complex and chronic care needs • Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care • Ensure member access to services appropriate to their health needs • Conduct assessments to identify individual needs and a specific care management plan • Implement care plan by facilitating authorizations/referrals as appropriate • Coordinate internal and external resources to meet identified needs • Monitor and evaluate effectiveness of the care management plan and modify as necessary • Interface with Medical Directors and Physician Advisors on the development of care management treatment plans • Assist in problem solving with providers, claims or service issues

Role Description 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. - Performing duties telephonically for discharge planning. How you will make an impact: - 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. Qualifications - Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. - Current, unrestricted RN license in applicable state(s) required. - Multi-state licensure is required if this individual is providing services in multiple states. Requirements - Certification as a Case Manager is preferred. - BS in a health or human services related field is preferred. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements).

Role Description The Audit & Reimbursement II is responsible for completing limited and full desk reviews on providers as assigned. How you will make an impact: - Performs audit work scoped by the desk reviews and will be the in-charge auditor on small and less complex audits. - Assists higher level auditor on field work and appeals as assigned. - Performs special audits of End Stage Renal Disease (ESRD) providers and provider exception requests as assigned. - Updates STAR, FISS and PSF as assigned. - Participates as a team member on audits of provider's records and other projects. - Analyzes and interprets data and makes recommendations for change based on their judgment and experience. - May perform Part A provider enrollment responsibilities as needed. - Associates in this role are expected to maintain continuing education requirements. Qualifications - Requires a BA/BS degree in Finance/Accounting/Business or any combination of education and related experience, which would provide an equivalent background. - This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States for at least three of the past five years. Requirements - Degree in Accounting preferred. - Knowledge of CMS program regulations and cost report format preferred. - Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred. - MBA, CPA or CIA preferred. - If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements).

Role Description RN Utilization Management Nurse (InPatient) – California Commercial This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Please Note: Associates in this job working from a California location are eligible for overtime pay based on California employment law. Work Hours: 8 hour shift between 7:30am – 6pm PST. Rotating Weekends and holidays. The Medical Management Nurse for California HMO is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member’s clinical presentation to determine whether to approve requested service(s) as medically necessary. Works with healthcare providers to understand and assess a member’s clinical picture. Utilizes nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy relevant clinical criteria. Acts as a resource for Clinicians. May work on special projects and helps to craft, implement, and improve organizational policies. Primary duties may include but are not limited to: - Utilizes nursing judgment and reasoning to analyze members’ clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. - Works with healthcare providers to promote quality member outcomes, optimize member benefits, and promote effective use of resources. - Determines and assesses abnormalities by understanding complex clinical concepts/terms and assessing members’ aggregate symptoms and information. - Assesses member clinical information and recognizes when a member may not be receiving appropriate type, level, or quality of care, e.g., if services are not in line with diagnosis. - Provides consultation to Medical Director on particularly peculiar or complex cases as the nurse deems appropriate. - May make recommendations on alternate types, places, or levels of appropriate care by leveraging critical thinking skills and nursing judgment and experience. - Collaborates with case management nurses on discharge planning, ensuring patient has appropriate equipment, environment, and education needed to be safely discharged. - Collaborates with and provides nursing consultation to Medical Director and/or Provider on select cases, such as cases the nurse deems particularly complex, concerning, or unclear. - Serves as a resource to lower-level nurses. - May participate in intradepartmental teams, cross-functional teams, projects, initiatives and process improvement activities. - Educates members about plan benefits and physicians and may assist with case management. - Collaborates with leadership in enhancing training and orientation materials. - May complete quality audits and assist management with developing associated corrective action plans. - May assist leadership and other stakeholders on process improvement initiatives. - May help to train lower-level clinician staff. Qualifications - Requires a minimum of associate’s degree in nursing. - Requires a minimum of 4 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would provide an equivalent background. - Current active, valid and unrestricted RN license to practice as a health professional within the scope of licensure in the state of California required. Requirements - Strong acute, inpatient clinical experience in areas such as Med/Surg, Critical Care, ER, Telemetry, etc. strongly preferred. - Utilization management/review within managed care or hospital strongly preferred. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).