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Elevance Health
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  • Pharmacy Tech II  

    - Marion County
    Pharmacy Tech II Hours: 12pm-8:30pm EST Location : This role enables a... Read More
    Pharmacy Tech II Hours: 12pm-8:30pm EST Location : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Pharmacy Tech II is responsible for the interpretation and data entry of moderately complex prescriptions, prior authorization processing, and troubleshooting adjudication issues. How you will make an impact: Verifies member information and inputs data for the pharmacists. Educates members on pharmacy based rules related to prescriptions and medication resources or assistance programs. Processes prior authorization requests from physicians, offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization determinations. Provides resolution to grievances and appeals issues. Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits. Generates reports relating to rebates, physician utilization, Beers Criteria, Reliance members, and other ad hoc reports. Maintains record keeping of prior authorizations, rebates, and monthly reports. Minimum Requirements: Requires an active, professional license, if required by state law, State Pharmacy Technician Certification or National Certification based on applicable state(s) requirements, to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States. Requires H.S. diploma or equivalent and minimum of 2 years of pharmacy experience; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences : Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills preferred. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) . Read Less
  • Regional Account Liaison - BioPlus Specialty Pharmacy (Greater Boston... Read More
    Regional Account Liaison - BioPlus Specialty Pharmacy (Greater Boston Territory) Sales Territory: Ideal candidates will reside in the Greater Boston territory and are comfortable traveling up to 50% of the time overnight throughout NH, VT, MA, ME, and RI This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Regional Account Liaison - BioPlus Specialty Pharmacy (Greater Boston Territory) is responsible for maximizing the client base and strengthening existing relationships within a set territory and achieving defined sales targets and demonstrating a strong understanding within disease states. How you will make an impact: Achieves sales of new accounts while maintaining relationships with existing accounts. Maintains sales effectiveness within the assigned territory. Utilizes databases and other tools to identify key accounts and maximize referral potential. Develops and fosters account relationships as well as maintains and documents a call cycle. Builds and extends relationships to pharmaceutical counterparts and maintains internal partnership. Supports all specialty pharmacy activity. Partners with leadership team to formulate and execute business objectives. Attends and participates in sales meetings, training programs, conventions, etc. Communicates all information regarding competitors, issues affecting territory, business threats, and relevant information to the leadership team. Minimum Requirements: Requires a BA/BS and a minimum of 6 years of relevant experience within the pharmaceutical, specialty pharmacy, or healthcare industry; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences: Experience in the following core therapies: Oncology, Gastroenterology, Dermatology, and /or Rheumatology. Willingness to travel. Understanding of specialty pharmacy. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $109,296 - $163,944 Location: Massachusetts In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) . Read Less
  • Group Underwriting Consultant  

    - Fulton County
    Group Underwriting Consultant Location: This role requires associates... Read More
    Group Underwriting Consultant Location: This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Group Underwriting Consultant underwrites and prices complex large group new business for the seven states in the west region. This is a highly visible role offering exposure to senior stake holders while working on accounts up to 15,000 members. How You Will Make an Impact Primary duties may include, but are not limited to: Participates in training of underwriting staff and sales staff. Calculates renewal rates for large complex cases based on thorough analysis of experience, location, demographics, etc. Determines and provides guidance to medical underwriters concerning the risk selection of applicants applying for individual health coverage. Coordinates with other departments to ensure accuracy and consistency of overall account reporting. Proposes rates for prospective business utilizing a combination of other carrier experience, demographic data and manual rates. Performs post-sale reviews. Prepares or supervises preparation of annual settlements, ERISA reports, rate projections, or benefit change increments and decrements. Surveys existing product portfolios by market, monitors sales results, trends and needs, recommends product portfolio changes. Assists in establishing rating and administrative procedures. Participates in major multi-functional teams as underwriting representative. Assists in the technical development of underwriting associates, which may include monitoring reports and work flow to provide recommendations on productivity and efficiency improvements. Updates and monitors departmental processes and procedures in compliance with system, regulatory and business requirements. Minimum Requirements: Requires a BA/BS in a related field; Minimum 5 years of related experience; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: Experienced in Medical Underwriting with a growth mindset to join the Anthem new business team. Experience as a proactive underwriter who excels in collaborating with sales teams to secure new business opportunities, all while ensuring alignment with our company's profitability and margin objectives. The ideal candidate will be adept at underwriting analysis with a creative approach to help us grow the commercial division For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $93,896 to $153,648. Locations: California; Illinois; Minnesota; New Jersey; New York In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws . The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) . Read Less
  • Nurse Appeals Associate  

    - Davidson County
    Nurse Appeals Associate Location: This role enables associates to work... Read More
    Nurse Appeals Associate Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Schedule: Monday - Friday; 10:00a 7:00p CST The Nurse Appeals Associate is responsible for supporting the development and implementation of quality improvement interventions and audits. How you will make an impact: Researches, collects data, and submits and resolves administrative appeals. Contributes to external reviews site visit preparations by the State, accreditation review and Quality Management Committee; conducts internal monitoring and audits timeline compliance standards. Processes, tracks, trends, and reports complaint and grievances issues. Prepares complaint and grievance files for Fair Hearings and serves as a subject matter expert on complaints and grievances for non-clinical staff. Participates in quarterly Plan HIPAA audits. Minimum Requirements: Requires an LVN/LPN and minimum of 1 year of related experience; or any combination of education and experience, which would require an equivalent background. Current unrestricted LPN/LVN license in applicable state(s) required. Preferred Skills, Capabilities and Experiences: Strong computer literacy skills is preferred. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) . Read Less
  • Nurse Practitioner 100% Virtual, CareBridge  

    - Cuyahoga County
    CareBridge Advance Practice Provider, Nurse Practitioner $5,000 sign o... Read More
    CareBridge Advance Practice Provider, Nurse Practitioner $5,000 sign on bonus Location: Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize Work Shift: (i.e. Monday - Friday, 8:00 am to 5:00 pm CST or EST And rotating on-call.) The CareBridge Advance Practice Provider, Nurse Practitioner is responsible for collaborating with company physicians, the patient's other physicians and providers, and their family members to develop complex plans of care in accordance with the patient's health status and overall goals and values. Provides clinical and non-clinical support to patients. How you'll make a difference: Provides primary and urgent health care via telephone and tele video modalities to patients who receive home and community-based services through state Medicaid programs, dual eligible members and other membership as assigned by our MCO partners. Develops and implements clinical plans of care for adult patients facing chronic and complex conditions (e.g., co-morbid medical and mental health diagnoses, limited personal resources, chronic medical conditions.). Gathers history and physical exam and diagnostics as needed, and then develops and implements treatment plans given the patient's goals of care and current conditions. Identifies and closes gaps in care. Meets the patient's and family's physical and psychosocial needs with support and input from the company's inter-disciplinary team. Educates patients and families about medication usage, side effects, illness progression, diet and nutrition, medical adherence and crisis anticipation and prevention. Maintains contact with other clinical team members, patients' other physicians and patients' other medical providers to coordinate optimal care and resources for the patient and his or her family in a timely basis and consistent with state regulations and company health standards and policy. Maintains patient medical records and medical documentation consistent with state regulations and company standards and policy. Participates in continuing education as required by state and certifying body. Prescribes medication as permitted by state prescribing authority. Minimum Requirements: Requires an MS in Nursing. Requires an active, national NP certification. Requires valid, current, active and unrestricted Family or Adult Nurse Practitioner (NP) license in the state(s) of Ohio. Requires valid, current, active, RN Compact license. (Recruiters - only post if it applies to states that offer Compact license, if it is a Non compact state, this would be listed under Preferences.) Requires 2+ years of experience in managing complex care cases. Experience working with Electronic Medical Records (EMR). Preferred skills, qualifications and experiences: Possession of DEA registration or eligibility preferred. Active Medicaid number in the state of Ohio is highly preferred. Experience in managing complex care cases for developmental disabilities and chronically ill patients strongly preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $110,080 to $165,120 Locations: Cleveland, OH; Columbus, OH In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. *The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the company's sole discretion, consistent with the law Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) . Read Less
  • CareBridge Advance Practice Provider, Nurse Practitioner Bilingual Sig... Read More
    CareBridge Advance Practice Provider, Nurse Practitioner Bilingual Sign on Bonus: $5,000 Seeking Bilingual Nurse Practitioners licensed in Texas and/or Arizona AND Must have an active RN Compact license. Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. Carebridge Health is a proud member of the Elevance Health family of companies within our Carelon business. Carebridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home care and community-based services. Location: Texas and Arizona Work Shift: Monday - Friday, 8:00 am to 5:00 pm CST And rotating on-call The Advance Practice Provider, Nurse Practitioner Bilingual is responsible for collaborating with company physicians, the patient's other physicians and providers, and their family members to develop complex plans of care in accordance with the patient's health status and overall goals and values. Provides clinical and non-clinical support to patients. How you will make an impact Primary duties may include but are not limited to Provides primary and urgent health care via telephone and tele video modalities to patients who receive home and community-based services through state Medicaid programs, dual eligible members and other membership as assigned by our MCO partners. Develops and implements clinical plans of care for adult patients facing chronic and complex conditions (e.g., co-morbid medical and mental health diagnoses, limited personal resources, chronic medical conditions.). Gathers history and physical exam and diagnostics as needed, and then develops and implements treatment plans given the patient's goals of care and current conditions. Identifies and closes gaps in care. Meets the patient's and family's physical and psychosocial needs with support and input from the company's inter-disciplinary team. Educates patients and families about medication usage, side effects, illness progression, diet and nutrition, medical adherence and crisis anticipation and prevention. Maintains contact with other clinical team members, patients' other physicians and patients' other medical providers to coordinate optimal care and resources for the patient and his or her family in a timely basis and consistent with state regulations and company health standards and policy. Maintains patient medical records and medical documentation consistent with state regulations and company standards and policy. Participates in continuing education as required by state and certifying body. Prescribes medication as permitted by state prescribing authority. Minimum Requirements: Requires an MS in Nursing. Requires an active national NP certification. Requires valid, current, active and unrestricted Family or Adult Nurse Practitioner (NP) license in the state of Texas and/or Arizona Experience working with Electronic Medical Records (EMR) required. Requires 2+ years of experience in managing complex care cases. Bilingual or Multi-language skills required. Preferred Skills, Capabilities and Experiences: Experience in managing complex care cases for developmental disabilities and chronically ill patients strongly preferred. Possession of DEA registration or eligibility preferred. Bilingual in Spanish is highly preferred Active Medicaid number in the state of Texas and/or Arizona is highly preferred. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) . Read Less
  • CareBridge Advance Practice Provider, Nurse Practitioner Bilingual Sig... Read More
    CareBridge Advance Practice Provider, Nurse Practitioner Bilingual Sign on Bonus: $5,000 Seeking Bilingual Nurse Practitioners licensed in Texas AND Must have an active RN Compact license. Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. Carebridge Health is a proud member of the Elevance Health family of companies within our Carelon business. Carebridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home care and community-based services. Location: Texas Work Shift: Monday - Friday, 8:00 am to 5:00 pm CST And rotating on-call The Advance Practice Provider, Nurse Practitioner Bilingual is responsible for collaborating with company physicians, the patient's other physicians and providers, and their family members to develop complex plans of care in accordance with the patient's health status and overall goals and values. Provides clinical and non-clinical support to patients. How you will make an impact Primary duties may include but are not limited to Provides primary and urgent health care via telephone and tele video modalities to patients who receive home and community-based services through state Medicaid programs, dual eligible members and other membership as assigned by our MCO partners. Develops and implements clinical plans of care for adult patients facing chronic and complex conditions (e.g., co-morbid medical and mental health diagnoses, limited personal resources, chronic medical conditions.). Gathers history and physical exam and diagnostics as needed, and then develops and implements treatment plans given the patient's goals of care and current conditions. Identifies and closes gaps in care. Meets the patient's and family's physical and psychosocial needs with support and input from the company's inter-disciplinary team. Educates patients and families about medication usage, side effects, illness progression, diet and nutrition, medical adherence and crisis anticipation and prevention. Maintains contact with other clinical team members, patients' other physicians and patients' other medical providers to coordinate optimal care and resources for the patient and his or her family in a timely basis and consistent with state regulations and company health standards and policy. Maintains patient medical records and medical documentation consistent with state regulations and company standards and policy. Participates in continuing education as required by state and certifying body. Prescribes medication as permitted by state prescribing authority. Minimum Requirements: Requires an MS in Nursing. Requires an active national NP certification. Requires valid, current, active and unrestricted Family or Adult Nurse Practitioner (NP) license in the state of Texas Experience working with Electronic Medical Records (EMR) required. Requires 2+ years of experience in managing complex care cases. Bilingual or Multi-language skills required. Preferred Skills, Capabilities and Experiences: Experience in managing complex care cases for developmental disabilities and chronically ill patients strongly preferred. Possession of DEA registration or eligibility preferred. Bilingual in Spanish is highly preferred Active Medicaid number in the state of Texas is highly preferred. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) . Read Less
  • Operations Expert - Paragon Healthcare  

    - Collin County
    Operations Expert - Paragon Healthcare Location: 3033 W President Geor... Read More
    Operations Expert - Paragon Healthcare Location: 3033 W President George Bush HWY., STE 100, Plano, TX Office Requirement: Hybrid 2; This role requires associates to be in-office 3 days per week: Tuesday, Wednesday, and Thursday, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Schedule: Monday Friday, 7:00 AM 7:00 PM Central Time, specific shifts during business hours will be discussed during the hiring process. A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting. The Operations Expert is responsible for providing technical direction, guidance and resources to claims, customer service, or membership associates on a day-to-day basis. How You Will Make an Impact Serves as a first line resource for operation associates for workflow and technical related processes. Provides operational training. Assists associates by answering day-to-day technical questions. Encourages a teamwork environment; monitors inventory to ensure workflow remains uninterrupted. Handles complex case research and resolution; reviews, interprets and maintains records of service level, quality, accuracy, and productivity. Reviews department policy and procedure manuals for accuracy. Works with training department to ensure procedures and policies are accurate and complete. Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers. Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment. Strong verbal and written communication skills, both with virtual and in-person interactions. Attentive to details, critical thinker, and a problem-solver. Demonstrates empathy and persistence to resolve caller issues completely. Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts. Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary. Performs other duties as assigned. Minimum Requirements: Requires HS diploma or equivalent and a minimum of 5 years related experience and a minimum of 3 years of experience and expertise with company relevant automated processing systems; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities, Read Less
  • Clinical Nurse Concierge - BioPlus Specialty Pharmacy Location: This r... Read More
    Clinical Nurse Concierge - BioPlus Specialty Pharmacy Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies . BioPlus offer consumers and providers an unparalleled level of service that's easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer's treatment journey. The Clinical Nurse Concierge is responsible for coordinating the care needs of assigned patients and develops comprehensive plans to manage care delivery across the patient care continuum. How you will make an impact: Introduce and inform current and new immunoglobulin patients and referral sources about the services and programs offered. Provide additional touchpoint to customers, be a resource for outside salespeople, and help solve problems as needed. Oversee the referral process and maintenance of EMR. Ability to thoroughly understand and explain organizations Infusion product offerings and key benefits to current and potential patients and physician customers. Act as the single point of contact for patients and referral sources ensuring high levels of customer satisfaction. Provide industry leading customer service and advocacy for BioPlus patients and customers. Intervene immediately when a potential bottleneck in our system may occur. Develop and distribute consumer/patient educational materials and resources. Communicate the story and explain competitive advantage. Discuss insurance limits and parameters of policy with patients prior to beginning services. Act as a liaison between home health agencies, home infusion center and physicians to coordinate discharge, plan for patient care and establish Plans of Treatment. Coordinate therapeutic monitoring pertinent to therapy with home health care agency, laboratory and specialty infusion center pharmacy. Coordinate pharmacy dispensing schedule with delivery of drugs and supplies. Verify disposable supplies are packed and are appropriate for patient needs. Coordinate with home health care agency, laboratory and specialty pharmacy for injectable self-administration teaching, lab coordination and shipment arrangements. Coordinate patient care at refill establishing current response to therapy and ADR/Adherence occurrences, forwarding all clinical calls to appropriate clinician, under the supervision of the pharmacist. Responsible for all activities and duties including but not limited to appropriate communications via progress notes, arranging nursing, patient communications, health care professional communications, completing scheduling board, as well as scheduling shipments via patient contact and communication in computer system, e-mail system and verbally. Coordination involvement and auditing of requirements of specific clinical programs as per policy and procedures. (REMS, IgG, Hemophilia, etc.) Participate in center QA or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities and Experiences: Prior IV therapy/infusion experience (infusion center, specialty pharmacy, or outpatient/hospital setting) preferred Case Management certification (e.g., CCM or equivalent) preferred Experience managing infusion medication prior authorizations, denials, and appeals end-to-end Ability to complete deep clinical chart reviews and identify the strongest clinical rationale for coverage Skilled in writing Letters of Medical Necessity tailored to payer criteria and patient-specific facts Proven success preparing and submitting 1st/2nd level appeals (standard and expedited) Experience supporting peer-to-peer reviews with concise clinical summaries and provider talking points Strong working knowledge of payer policies/medical necessity criteria for infusion therapies (step therapy, site-of-care, documentation requirements) Ability to use clinical guidelines and evidence to support approvals and overturn denials Detail-oriented in compiling complete, accurate documentation (records, labs, imaging, prior treatment history) Strong collaboration skills with providers, nurses, pharmacy, and revenue cycle/PA teams to prevent treatment delays Track record of improving outcomes (e.g., higher approval/overturn rates, faster turnaround times, fewer repeat denials ) Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) . Read Less
  • LPN/LVN 100% Virtual, CareBridge  

    - Ada County
    Carebridge LPN/LVN CareBridge Health is a proud member of the Elevance... Read More
    Carebridge LPN/LVN CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services. Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Shift: Full time (40 hours a week) position that will require holidays and weekend rotation. The LPN/LVN is responsible for the examination and treatment of patients under the direction of the physician. How you will make an impact: Reviews patient medical records, interviews patients and records vital signs. Provides nursing interventions and coaching in accordance with the scope of practice and standing orders. Facilitates patient transfers to alternate level of care. Facilitates patient transfers to an alternate level of care as needed. Documents using standard templates. Ability to be on the phone engaging with patients up to 80% of the shift. Ability to work assigned weekends per standard team rotation. Reliable internet and a high level of customer service. Minimum Requirements: Requires an LPN or LVN and minimum of 2 years of experience as an LPN/LVN; or any combination of education and experience, which would provide an equivalent background. Current LPN/LVN license in the applicable state required. For Carelon Health business unit, satisfactory completion of a Tuberculosis test is a requirement for this position. Preferred Experience, Skills, and Capabilities: Bi-lingual (English/Spanish) preferred. Experience with Telephonic Triage preferred. Acute care experience (e.g., urgent care or ER) preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $24.99 p/h to $31.25 p/h. Locations: New Jersey and Washington State. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws . The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) . Read Less

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