Jobs at Elevance Health

Reviews complex member cases to determine medical necessity using nursing judgment, clinical guidelines, and policy. Collaborates with providers, Medical Directors, and case management nurses on care decisions, discharge planning, member education, quality audits, training, and process improvement. Requires an active unrestricted RN license and relevant care management, case management, clinical, utilization review, or managed care experience.

Leads enterprise AI and machine learning strategy, designs and scales production systems, translates business challenges into measurable AI outcomes, establishes governance and technical standards, and mentors data science and machine learning teams. Responsibilities span model training, evaluation, deployment, monitoring, lifecycle management, and collaboration with business and technology leaders.

Oversee the Threat Management/Workplace Violence Prevention Program: assess and manage threats, support preparedness and response, conduct/internal investigations using case management software, develop policies and training, and coordinate with regional security, HR, legal, and management. Must support crisis response nights/weekends and work U.S. Eastern Time business hours; hybrid in-office presence required.

Leads CarelonRx infusion sales growth across the West Coast by developing strategy, managing and coaching a field sales team, expanding physician and specialty referral relationships, and achieving revenue, admissions, margin, and profitability goals. Focuses on home infusion growth in neurology and immunology, including IVIG and other specialty therapies. Provides field leadership, training, market analysis, strategic account development, and cross-functional collaboration while traveling extensively throughout the assigned region.

Leads pharmacy benefit management client accounts and PBM vendor contracts across the West Region. Oversees contract strategy, pricing, rebate analysis, network compliance, policy implementation, and client satisfaction. Manages account executives and account managers, including hiring, coaching, performance evaluation, and career development. Builds relationships with vendors and stakeholders, supports retention and upselling opportunities, negotiates expectations, and presents recommendations to senior executives. Travel to meetings and events is required as needed.

Leads provider network development and complex contract negotiations with large health systems and affiliated physician groups. Serves as a contracting subject matter expert, manages enterprise network initiatives, supports network planning, develops staff, and conducts financial projections and rate analysis. The role requires expertise in value-based contracting, shared savings, ACO development, provider relations, customized fee schedules, and negotiations across Commercial, Medicaid, and Medicare lines of business.

Build and manage client relationships for clinical pharmacy accounts, respond to inquiries, deliver reports, support RFPs, and coordinate business-unit discussions. Develop savings and revenue recommendations, implement programs, analyze client data for trends and gaps, and support commercial and Medicare business. The role requires strategic thinking, executive-level communication, presentation, negotiation, and problem-solving skills, with field-based client engagement across Pacific and Mountain time regions.