Elevance Health

Role Description The Medical Management Clinician Associate is responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies. 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: - Confirms medical services are appropriate based on assigned benefit plan, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure. - Work may be facilitated, in part, by algorithmic or automated processes. - Handles less complex benefit plans and/or contracts. - Conducts and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract. - May process a medical necessity denial determination made by a Medical Director. - Refers complex or non-routine reviews to more senior nurses and/or Medical Directors. Qualifications - Requires H.S. diploma or equivalent. - Requires a minimum of 2 years of clinical experience and/or utilization review experience. - Current active, valid and unrestricted LPN/LVN or RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required. Multi-state licensure is required if this individual is providing services in multiple states. Requirements - For candidates working in person or virtually in the below locations, the salary range for this specific position is $28.44 - $42.67. - Locations: New York. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Role Description 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. Work Hours: Monday - Friday 12:30pm-9:00pm EST, some holiday hours required as determined by business needs. The Workforce Management Analyst I - Real Time Analyst monitors call volume demand in real time and flexes workforce accordingly. Ensures that the best possible call center service levels are achieved to maximize utilization. Monitors call volume and average speed of answer (ASA) in real time & adjusts schedules to ensure consistent service is maintained. - Monitors and reacts to fluctuations in call volume as they occur in order to restore service levels as quickly as possible. - Schedules activities around forecasted call patterns. - Schedules off-phone activities when call volume projections are down. - Manages and adjusts call routing when unusual call patterns exist in order to ensure service levels are met. - Updates schedules to ensure WFM system is able to provide statistical staffing requirements based upon current staffing availability. - Updates schedules to account for breaks, paid time off, tardiness, etc. Qualifications - Requires a H.S. diploma and a minimum of 2 years call center operations experience; or any combination of education and experience which would provide an equivalent background. Requirements - Real-time management experience in a centralized call center environment is preferred. - Previous experience with MS Excel, Tableau, Coding Database (DBA) is strongly preferred. - Prior working knowledge of Genesys Cloud and/or NICE IEX is strongly preferred. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements).

• Identifies opportunities for engagement of members and their families in forming a supportive, recovery network • Develops and implements provision of onsite psychiatric discharge planning education at Recovery and Resiliency sites • Collaborates with Stabilization Teams as a member advocate in discharge planning education, resolution of barriers, and service transitions • Acts as a resource for staff on decision making and problem solving • Initiates and maintains contact with assigned individuals and providers to determine members response to services

Role Description CareBridge Advance Practice Provider, Nurse Practitioner $5,000 Sign-on Bonus - Seeking Nurse Practitioners licensed in either of the following states: TX, KS, or IA - Must have an active RN Compact license Location: 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 an accommodation is granted as required by law. The Advance Practice Provider, Nurse Practitioner is responsible for collaborating with company physicians, the patient’s other physicians and 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. 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 the state(s) of TX, KS, or IA. - Requires valid, current, active, RN Compact license. - Requires 2+ years of experience in managing complex care cases. - Experience working with Electronic Medical Records (EMR). Requirements - Possession of DEA registration or eligibility preferred. - Active Medicaid number in the state of TX, KS, or IA is highly preferred. - Experience in managing complex care cases for developmental disabilities and chronically ill patients strongly preferred. 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.

Role Description The Outreach Care Specialist II is responsible for ensuring that appropriate member treatment plans are followed on moderately complex cases and for proactively identifying ways to improve the health of our members and meet quality goals. - Coordinates follow-up care plan needs for members by scheduling appointments or enrolling members in programs. - Assesses member compliance with medical treatment plans via telephone or through on-site visits. - Identifies barriers to plan compliance and coordinates resolutions. - Identifies opportunities that impact quality goals and recommends process improvements. - Recommends treatment plan modifications and determines need for additional services, in conjunction with case management and provider. - Coordinates identification of and referral to local, state or federally funded programs. - Coaches members on ways to reduce health risks. - Prepares reports to document case and compliance updates. - Establishes and maintains relationships with agencies identified in appropriate contract. - Serves as preceptor for new associates and participates in or leads projects with cross-functional teams. Qualifications - Requires a high school diploma and a minimum of 3 years related experience; or any combination of education and experience which would provide an equivalent background. - Certified nurse assistant or certified medical assistant and/or BS/BA degree in a related field preferred. - Bilingual candidates preferred. Requirements - For candidates working in person or virtually in the below locations, the salary range for this specific position is $24.06/hr to $30.07/hr. - Location(s): Washington. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Role Description The Medical Management Clinician Senior will be responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies. May collaborate with healthcare providers. Focuses on relatively complex case types that do require the training or skill of a registered nurse. Acts as a resource for more junior Clinicians. - Responsible for complex cases that may require evaluation of multiple variables against guidelines when procedures are not clear. - Serves as a resource to lower-level clinicians and staff. - May collaborate with leadership to assist in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. - Assesses and applies medical policies and clinical guidelines within scope of licensure. - Conducts and may approve pre-certification, concurrent, retrospective, out of network and/or appropriateness of treatment setting reviews by utilizing appropriate medical policies and clinical guidelines in compliance with department guidelines and consistent with the members eligibility, benefits and contract. - May process a medical necessity denial determination made by a Medical Director. - Develops and fosters ongoing relationships with physicians, healthcare service providers and internal and external customers to help improve health outcomes for members. - Refers complex or unclear reviews to higher level nurses and/or Medical Directors. - Does not issue medical necessity non-certifications. - Collaborates with leadership in enhancing training and orientation materials. - May assist leadership and other stakeholders on process improvement initiatives. - May help to train lower-level clinician staff. Qualifications - Requires H.S. diploma or equivalent. - Requires a minimum of 6 years of clinical experience and/or utilization review experience. - Current active, valid and unrestricted LPN/LVN or RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required; or any combination of education and experience which would provide an equivalent background. - Multi-state licensure is required if this individual is providing services in multiple states. Requirements - Virginia residency preferred. - RN license in the state applicant resides in is highly preferred. - Prior LTSS experience highly preferred. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). - Merit increases, paid holidays, Paid Time Off, and incentive bonus programs. - Medical, dental, vision, short and long term disability benefits. - Life insurance, wellness programs, and financial education resources.

Role Description 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. Under general guidance and mentoring, the Associate Manager of Clinical Support - CareBridge is responsible for overseeing and monitoring the day-to-day workflow of clinical support staff. - Serves as a subject matter expert in the administrative and operational processes. - Assists in problem solving complex issues and cases, such as provider calls, e-services, and authorization issues. - May answer calls from providers and members and responds to phone inquiries. - Oversees out of network and chart review administrative processes. - Works to streamline processes to ensure productivity and accuracy. - Collaborates with internal departments on special projects and reporting. - Hires, trains, coaches, counsels, and evaluates performance of direct reports. Qualifications - Requires high school diploma or equivalent with experience in the health field; or any combination of education and experience, which would provide an equivalent background. - BA/BS degree in human services preferred. - Previous health care leadership experience such as in an assisted living or skilled nursing facility. - Previous experience monitoring and reviewing team metrics, pulling reports and presenting to leadership. Requirements - Work hours: 8am - 5pm CST - Location(s): Nevada, Colorado - Salary range for this specific position is $57,760 to $95,304. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). - Merit increases, paid holidays, Paid Time Off, and incentive bonus programs. - Medical, dental, vision, short and long term disability benefits. - Stock purchase plan, life insurance, wellness programs, and financial education resources.

Role Description The Manager Patient Engagement Specialist, under general guidance and mentoring, provides oversight of a customer service unit. - May be responsible for establishing department policies and procedures. - Audits to monitor efficiency and compliance with policies, prepares specialized reports, may be assigned to special project work consistent with the role and dictated by the needs of the business. - Hires, trains, coaches, counsels, and evaluates performance of direct reports. Qualifications - Requires BA/BS degree and a minimum of 5 years in customer service environment; or any combination of education and experience which would provide an equivalent background. Requirements - Shift: Monday – Friday, 8:00am – 5:00pm, with occasional weekend coverage. - Location: Virtual, Alternate locations may be considered if candidates reside within a commuting distance from an office. - This role enables associates to work virtually full-time, with the exception of required in-person training sessions. - 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. Benefits - Market-competitive total rewards including 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.

Role Description Pharmacist - Data Analytics LOCATION: This is a virtual eligible role. You must be within a reasonable distance of a PulsePoint. HOURS: General business hours, Monday through Friday, local time. 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. 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. Responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS and formulary management. Please note: This is NOT a dispensing role; it is an analytics role. You must be a licensed pharmacist in the U.S., and you must be proficient in the tools listed under "preferred qualifications". Primary duties may include, but are not limited to: - Researches and synthesizes detailed clinical data related to pharmaceuticals. - Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee. - May review and approve or deny coverage for pharmaceuticals based on medical necessity criteria, and coordinates with internal stakeholders or health plan medical directors as needed. - Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions. - Prepares information for network physicians. Qualifications - Requires BA/BS in Pharmacy. - Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background. - Requires a registered pharmacist. - Current unrestricted Pharmacist license from the state in which you reside is required. Requirements - Experience working with Tableau or Power BI is absolutely essential for this role! - Experience working with tools like SQL, Python and R is very strongly preferred. - You must have data analytics experience for this position. - PharmD preferred. - Experience working with Medicare and STARS data strongly preferred. - Associates in this role are expected to have 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 Telephonic Nurse Case Manager II Sign on Bonus: $3000 Location: Virtual - 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. Hours: Monday - Friday 10:30 AM - 7 PM CST. *****This position will service members in different states; therefore, Multi-State Licensure will be required. The Telephonic Nurse Case Manager II is responsible for 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 or on-site such as at hospitals 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. - Assists with development of utilization/care management policies and procedures. Qualifications - Requires BA/BS in a health related field and minimum of 5 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).