Elevance Health

The Outreach Care Specialist is responsible for ensuring appropriate member treatment plans are followed for less complex cases and proactively identifying ways to improve member health and meet quality goals. Primary duties involve coordinating follow-up care, assessing treatment plan compliance via phone or on-site visits, identifying barriers, and recommending plan modifications or additional services.

The Grievance/Appeals Representative I will review, analyze, and process claims according to policies and events to determine company liability and entitlement, conducting investigations into customer grievances and appeals regarding service provision and benefit coverage issues. This role involves contacting customers to gather information, communicating case dispositions, documenting interactions, generating written correspondence, and performing research to resolve inquiries.

The Resource & Referral Follow-up Coordinator provides follow-up services for individuals contacting the helpline, ensuring they receive appropriate resources and successfully access recommended behavioral health services. Key duties include conducting outbound follow-up calls or emails, confirming linkage efforts, troubleshooting barriers, reviewing safety plans, and coordinating referrals to local, state, or federally funded programs.

The consultant provides 24/7 Behavioral Health and Employee Assistance services to millions of lives by responding to initial customer contacts, assessing situations, and determining the appropriate course of action. This includes providing telephone or on-site support for crisis intervention, short-term problem resolution, and referrals to appropriate providers, as well as managing Critical Incident Stress Debriefing requests.

The Senior Engineer is responsible for the end-to-end delivery of application and system development, maintenance on complex multi-technology platforms, and coordinating with product and client services to determine business requirements. Key activities include designing, developing, and maintaining backend services using Elixir and the Phoenix framework, contributing to CI/CD, and troubleshooting issues in AWS.

The Utilization Management Representative I coordinates cases for precertification and prior authorization review, managing incoming calls or post-service claims work, and determining contract and benefit eligibility. This role involves providing authorization for various requests, referring clinical cases to a Nurse reviewer, and entering referral data into the UM system.

The Pharmacy Customer Associate II is responsible for responding to basic customer inquiries via phone and written correspondence concerning retail and mail order pharmacy prescriptions. This involves developing positive customer relations and coordinating internally to ensure timely resolution of customer requests.

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. Duties are performed telephonically or on-site, such as at hospitals for discharge planning.

The Medical Management Nurse Lead serves as the team lead, coach, and technical resource for a team of nurses or clinicians, contributing to hiring and policy improvement decisions. This role involves leading process improvements, coordinating coverage, providing training, completing quality audits, and assisting with complex case reviews.

The Telephonic Nurse Disease Management I is responsible for participating in the delivery of patient education and disease management interventions, and for performing health coaching for members across multiple lines for chronic disease management programs. Responsibilities include conducting behavioral or clinical assessments, identifying health coaching plan needs, interfacing with providers, implementing coaching plans, and using motivational interviewing to facilitate health behavior change.