Jobs at Elevance Health

Support pricing for Individual and Small Group ACA markets by building and maintaining rating models, developing pricing strategies, preparing regulatory rate filings, collaborating on special pricing projects, and training junior actuarial staff. Requires actuarial exam progress and strong technical skills.

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.

Serves as chief of staff to the President of Carelon Pharmacy, driving strategic clarity, translating strategy into projects and timelines, monitoring business performance, supporting executive decision forums, and enabling cross-functional alignment to achieve enterprise priorities. Develops executive materials, oversees planning and project activities, and identifies opportunities to improve results. Hybrid role with occasional travel to worksites.

Lead enterprise performance management and OKR governance across Carelon; build executive reporting and dashboards, provide data-driven strategic advice to leadership, drive alignment across business units, and manage a team to ensure measurable outcomes and informed decision-making.

Manage retention and operational excellence for a complex book of pharmacy-benefit accounts. Build client and broker relationships, resolve operational issues, support implementations and renewals, track account performance using data, manage contractual obligations, and mentor junior account staff to drive retention and growth.

Lead the Strategic Portfolio Office to translate strategy into measurable outcomes by establishing portfolio discipline, governance, and operating models. Enable AI, automation, and platform programs to move from POC to production, drive investment prioritization and value realization, build executive-grade reporting and decision materials, and develop enterprise execution capabilities across federated teams.

Provide telephonic crisis intervention, safety screenings and assessments for callers to the Massachusetts Behavioral Health Helpline. Triage risk, develop action plans, document interactions, coordinate referrals and follow-up, and connect callers to resources while ensuring regulatory compliance.

Lead enterprise M&A strategy and execution: source, evaluate, structure, negotiate, and close transactions. Drive post-close integration and value realization, build financial models, advise executives, improve M&A processes, and lead a high-performing corporate development team.

Design, develop, and maintain complex technology platforms; code, test, and integrate system components; build, validate, and deploy statistical and machine learning models; extract and analyze clinical data; document requirements; collaborate with stakeholders; mentor peers and perform code reviews.

Lead design and implementation of predictive modeling projects using large-scale data (Hadoop/Spark), develop proprietary algorithms, recommend batch and real-time scoring, build advanced visualizations, deliver actionable insights, and mentor data scientists while collaborating with business partners.

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.

Lead analysis of complex business needs driven by federal and state mandates; evaluate regulatory impacts on processes/systems; define application software requirements; mentor lower-level consultants; lead analyst teams on high-impact projects; design solutions and support testing to ensure regulatory compliance.

Lead Elevance Health's enterprise business resilience program, serve as enterprise Incident Commander for high-severity events, coordinate cross-functional recovery (including cyber/ransomware), advise senior executives, design resilience strategies, run executive training and tabletop exercises, manage resilience tools, risk modeling, and global program delivery to ensure rapid recovery of critical operations.