Teams 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.