Jobs at Elevance Health

Provide telephonic care management for members with complex/chronic needs: assess, develop, implement, coordinate and monitor individualized care plans; facilitate authorizations/referrals; coordinate resources; interface with Medical Directors and providers; negotiate reimbursement rates and assist with provider, claims, or service issue resolution.

Lead development and management of provider networks with emphasis on contracting and relationship management for complex providers, negotiate non-standard contracts and fee schedules, mentor contracting staff, prepare financial projections and analyses, and collaborate across teams including sales and enterprise projects.

Support pricing strategies and rating model development for individual and small-employer commercial markets. Build and maintain actuarial models, analyze and forecast risk/data, coordinate special pricing projects, and prepare regulatory rate filings with internal teams and state/federal agencies.

Write, edit, and advise on marketing and sales communications (proposals, presentations, retention materials) for presale and acquisition/retention. Partner with business and creative teams, ensure legal and brand compliance, assess communication effectiveness, and recommend efficiency and clarity improvements.

Lead and execute enterprise strategy projects: identify and prioritize initiatives, manage cross‑functional programs, perform advanced analyses, present recommendations to senior leadership, facilitate large working sessions, and coach teams on continuous improvement and metrics reporting.

Senior HR strategic advisor partnering with C-suite to shape workforce strategy, organizational design, leadership capability, and culture. Leads enterprise workforce planning, predictive analytics, large-scale change initiatives, cross-functional HR alignment, executive coaching, and measurement of talent program ROI to drive organizational performance and resilience.

Lead architecture, development, and deployment of large-scale AI systems and platforms. Define enterprise AI standards, modernize legacy systems, implement AI-enabled SDLC and governance, mentor engineers, and drive adoption of LLMs, agentic AI, microservices, cloud, and DevOps practices.

Lead pharmacy operations for clinical program implementations, develop policies and procedures, oversee regional program rollouts, monitor metrics and budgets, drive process improvements, and recruit/train and manage pharmacy operations staff to meet clinical quality standards.

Lead and coach Agile teams to ensure delivery predictability and remove impediments. Facilitate Scrum/Kanban ceremonies, manage stakeholder communications, track dependencies, support release coordination across distributed teams, and drive continuous improvement for medium-to-large technical systems.

Review complex medical claims and determine benefit eligibility using medical policy. Assess medical necessity and reasonableness, document determinations, and apply utilization review/medical management criteria. Remote work with required onboarding training; requires RN license and clinical experience.

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.

Perform actuarial and statistical analyses to support commercial rate determination, update pricing and forecasting models, validate and prepare data, assist with regulatory filings, mentor analysts, and contribute to new product pricing and special projects.

Lead international tax compliance and planning, manage Forms 5471/8858, calculate GILTI/Subpart F/FDII, support ASC 740 tax provision, handle international audits, perform tax due diligence, mentor junior staff, and partner on tax technology and process improvements.

Lead design and execution of AI compliance monitoring, audits, and control assessments. Develop risk-based monitoring plans, implement automated monitoring, synthesize findings into reports, advise on controls and remediation, and build training and oversight frameworks.

Audit inpatient medical records to evaluate coding and DRG assignment accuracy (MS-DRG, APR-DRG), generate recoverable claims, produce audit findings, and recommend process improvements using ICD coding expertise and auditing tools.

Serve as statistical lead for complex clinical research: design studies, develop sample size calculations and statistical analysis plans, oversee analyses and teams, mentor statisticians, contribute to grants and publications, present findings to stakeholders, and support business development for externally funded research programs.