Jobs at Elevance Health

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.

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 PBM product strategy and execution for clinically driven solutions across commercial and government segments. Partner with cross-functional teams to develop formulary, utilization management, and specialty pharmacy product bundles, ensure regulatory compliance, monitor market trends, drive P&L outcomes, and support go-to-market and client-facing activities.

Coordinates wellness and recovery services for members, engages families and providers, supports psychiatric discharge planning, resolves service-transition barriers, and advocates for members. The specialist maintains contact with assigned individuals, provides education at recovery sites, supports stabilization teams, and assists staff with decision-making and problem-solving. Requires an associate degree and two years of relevant health services, behavioral health, or peer-support experience, plus active recovery or peer/family support certification.

Provide telephonic crisis intervention and de-escalation, screen and assess callers, develop and monitor care plans, coordinate internal/external resources, support non-clinical call takers, lead shifts in manager absence, monitor call volumes and staff availability, and participate in cross-functional projects to improve operations and member outcomes.

Perform and supervise complex Medicare cost report desk reviews and audits, prepare work papers per Government Auditing Standards and CMS requirements, analyze reimbursement data, handle appeals and exception requests, mentor junior staff, participate in special projects, and support CMS contractual workload with occasional travel and required training.

Review paid claims to identify and validate overpayments, calculate amounts, process refunds and claim adjustments, research voluntary refunds, balance accounts, perform collection activities, and collaborate with internal teams to maintain cash application and accounts receivable accuracy.

Validate paid claims for overpayments, calculate and process refunds, research voluntary refunds, balance accounts, perform collections and cash application tasks, and collaborate with internal teams to resolve routine claim and payment issues.

Evaluate medical necessity and appropriateness of outpatient behavioral health care (primarily ABA), conduct pre-certification, concurrent review and appeals, collaborate with providers/BCBAs and Medical Directors, mentor care management staff, and assist development of psychological/neuropsych testing programs.

Provide telephonic crisis intervention for the MA Behavioral Health Helpline: screen and assess safety risk, de-escalate, develop action plans, document interactions, coordinate referrals and follow-up, and ensure regulatory compliance.

Manage nurse practitioner team and clinical program operations, oversee patient caseloads, perform exams, order and interpret diagnostic tests, prescribe treatments, ensure documentation compliance, and hire/train/evaluate staff.