Jobs at Elevance Health

Internal Business Change Manager position within Elevance Health’s Business Support job family. The posting provides no specific responsibilities, qualifications, technologies, salary, travel requirements, or clearance information. The role follows a hybrid workforce strategy, generally requiring onsite work at least once per week unless designated primarily virtual.

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.

Provides administrative support for new and renewal sales business, including RFP coordination, system updates, sales data tracking, reporting, and resolution of routine sales, claims, and benefits issues. Partners with sales, account, proposal, broker, and client teams; maintains relationships, recommends process improvements, and completes special 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.

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.

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.

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.

Review and determine medical necessity for behavioral health outpatient services (including ABA and ASD), conduct precertification, concurrent review, and appeals, collaborate with providers and Medical Directors, mentor care management staff, and assist program development for psychological and neuropsychological testing.

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.