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  • Performance Quality Analyst II

    Carebridge 3.8company rating

    Columbus, OH job

    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 Performance Quality Analyst II is responsible for driving service quality excellence by evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries. How you will make an impact: * Assists higher level auditor/lead on field work as assigned and acts as auditor in charge on small and less complex audits. * Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding, member and provider inquiries, enrollment & billing transactions and the corrective action plan process. * Demonstrates ability to audit multiple lines of business, multiple functions, and multiple systems. * Analyzes and interprets data and makes recommendations for change based on judgment and experience, applies audit policy, and assesses risks to minimize our exposure and mitigate those risks. * Works closely with the business to provide consultation and advice to management related to policy and procedure identified as out of date or incomplete and investigates, develops and recommends process improvements and solutions. * Functions as a subject matter expert for discrepancy review, questions from team and business partners, and interpretation of guidelines and audit process. * Acts as a mentor to peer auditors, providing training and managing work and projects as necessary. Minimum Requirements: Requires a BS/BA; a minimum of 3 years related experience in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector), including a minimum of 1 year related experience in a quality audit capacity; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: * WGS Claims processing experience strongly preferred. * Experience/knowledge with local claim processing. * Understanding of individual member benefits and cost shares preferred. * Understanding of small, large and national group benefits and cost shares preferred. * Prefer contract language. 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 ******************************************** 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.
    $61k-83k yearly est. Auto-Apply 60d+ ago
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  • Therapy Services Specialist (Bilingual Korean Required)

    Carebridge 3.8company rating

    Columbus, OH job

    Sign-On Bonus: $3,000 The Therapy Services Specialist (Bilingual Korean Required) is responsible for working under the guidance of occupational therapist, collaborate with the managed care organization to support persons aging in place receiving home or community-based services. Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), 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 accommodation is granted as required by law. How you will make an impact: * Performs telephonic and/or virtual assessments to identify participants needs. * Provides recommendations to MCO for type and hours of supportive services required. * Conduct objective assessments for program participation to determine the appropriate level of support and services required. * Obtain participant history to inform the comprehensive assessment. * Complete assessments annually or more frequently as needed in accordance with applicable program requirements and participants needs. * Educate program participants and MCO representative on options for home modifications, DME, assistive technology, or other adaptive equipment. * Assists clinical team with the recommendations for equipment and services as needed. Collaborate with the support team to report observations and outcomes. * Document all member encounters per documentation standards. Minimum Requirements: * Requires graduate of a college level program in physical therapy, occupational therapy, or an accredited two-year program for a Physical Therapist Assistant or Occupational Therapist Assistant and minimum of 2 years' experience in social service or health care field; or any combination of education and experience, which would provide an equivalent background. * Current active, valid and unrestricted license or certification as a physical therapist assistant or occupational therapist assistant in applicable state required. Certification and/or licensure appropriate to field of specialty as required. * Bilingual Korean Required. 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 ******************************************** 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.
    $31k-46k yearly est. Auto-Apply 60d+ ago
  • LTSS Transition Concierge Coordinator

    Carebridge 3.8company rating

    Columbus, OH job

    LTSS Concierge Coordinator (Case Manager) Hiring statewide across Ohio This position is primarily virtual but may require you to work in the field based on business need up to 10% of the time. Location: 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. 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 MyCare Ohio health plan is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. The LTSS Transition Concierge Coordinator is responsible for supporting the LTSS Transition Coordinator (or contracted provider) in contributing to the components of the person-centered planning process, within Transitions of Care, for individuals enrolled in specialized programs, as required by applicable state law and contract, and federal requirements. Supports in the development, monitoring, and assessment of changes during any transitions of care into the Service Coordination forms and tools, such as the individual's Person-Centered Support Plan (PCSP) in accordance with member's needs. Supports individuals in meeting their established goals, in the setting of their choice, and accessing quality health care services and supports. How you will make an impact: * Responsible for performing telephonic and/or virtual outreach to individuals in specialized programs, providers, or other key stakeholders to support the efficacy of the care plan and/or to align with contractual requirements for member outreach, such as coordination and management of an individual's LTSS waiver, behavioral health or physical health needs. * Responsible for in-person visits, as needed, to accommodate business need. * Submits utilization/authorization requests to utilization management with documentation supporting and aligning with the individual's care plan. * Utilizes tools and pre-defined identification process, consults with the primary service coordinator to monitor the PCSP, in instances in which a risk is identified related to the members LTSS, physical or behavioral health supports (including, but not limited to, potential for high-risk complications). * Engages the primary service coordinator and other clinical healthcare management and interdisciplinary teams to provide care coordination support. * Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports. * At the direction of the member, documents their short- and long-term service and support goals in collaboration with the member's chosen care team that may include, caregivers, family, natural supports, and physicians. * Identifies members that would benefit from an alternative level of service or other waiver programs. * May also serve as mentor, subject matter expert or preceptor for new staff, assisting in formal training of associates and may be involved in process improvement initiatives. * Responsible for reporting critical incidents to appropriate internal and external parties such as state and county agencies (Adult Protective Services, Law Enforcement). * Assists and participates in appeal or fair hearings, member grievances, appeals and state audits. Minimum Requirements: * Requires BA/BS degree and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: * Strong computer skills to include Excel, Outlook and Electronic Medical Records highly preferred. * BA/BS degree field of study in health care related field preferred. * Strong preference for case management experience with older adults or individuals with disabilities. * Specific education, years, and type of experience may be required based upon state law and contract requirements 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 ******************************************** 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.
    $43k-59k yearly est. Auto-Apply 60d+ ago
  • Manager, Medical Director - Transformation Initiatives

    Carebridge 3.8company rating

    Columbus, OH job

    Location: This role requires associates to be in-office 3 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. 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. Alternate locations may be considered. The Manager, Medical Director will serve as a clinical and strategic advisor to enterprise transformation programs spanning affordability, medical cost management, modernization, and growth initiatives. This role provides medical and clinical leadership to ensure that large-scale technology, operations, and product initiatives align with clinical best practices, regulatory requirements, and the organization's goals of affordability, quality, and innovation. The Medical Director will work closely with engineering, product, operations, and business leaders to shape transformation strategies, assess clinical and financial impacts, and guide implementation of initiatives that impact providers, members, and clients across the healthcare ecosystem. How you will make an impact: Strategic Clinical Leadership * Provide clinical insight and medical guidance across multiple enterprise transformation initiatives, including: * Medical Cost Management * HealthOS and enterprise data platforms * Real-time Decisioning & Analytics (RDA) * Cost of Care / Payment Integrity * Care Management / Utilization Management (CM/UM) Modernization * Provider Networking & Modernization * Value-Based Care and Carelon Risk models * Carelon Research & Data Commercialization * Client Information Insights and CDIP/Consumer Experience * Advise on Teradata/SAS migration and retirement, ensuring data modernization supports clinical and operational needs. * Translate complex clinical and regulatory requirements into actionable technical and operational strategies. Program & Initiative Support * Partner with SVRO (Strategic Value Realization Office) and enterprise transformation leaders to assess clinical and medical cost implications of strategic initiatives. * Evaluate program designs for alignment with quality, safety, and evidence-based clinical practice. * Guide affordability-focused programs with a balance of cost containment, care quality, and provider/member experience. Collaboration & Influence * Collaborate with engineering, analytics, and product teams to ensure platforms such as HealthOS and RDA incorporate clinical intelligence and deliver actionable insights. * Advise Carelon Research and Data Commercialization teams on ethical and clinically appropriate use of healthcare data. * Partner with Provider Network leaders to shape modernization strategies that drive value-based outcomes and affordability. * Serve as a clinical voice in modernization of CM/UM platforms, ensuring alignment with regulatory mandates and member engagement expectations. Regulatory & Compliance Oversight * Ensure compliance with clinical, accreditation, and regulatory standards across transformation programs. * Support interpretation of federal/state mandates and advise on clinical implementation strategies. Minimum Requirements: * Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). * Must possess an active unrestricted medical license to practice medicine or a health profession. * Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. * Minimum of 10 years of clinical experience: or any combination of education and experience, which would provide an equivalent background. Preferred Qualifications: * 5+ years of clinical practice experience, with transition into payer, managed care, or healthcare leadership preferred. * Experience advising medical cost management, utilization management, payment integrity, or provider performance programs preferred. * Strong understanding of healthcare data systems (claims, EHR, analytics platforms) and payer operations preferred. * Proven ability to influence cross-functional teams and guide complex, enterprise-level initiatives. * Prior leadership in a payer, health plan, or healthcare innovation organization preferred. * Familiarity with enterprise platforms such as Teradata, SAS, or cloud-based data ecosystems. * Experience in value-based care, population health, and care management program design preferred. * Understanding research and data commercialization within healthcare. * Ability to communicate effectively with technical, clinical, and executive stakeholders. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $291,900 to $500,400 Locations: California, Colorado, District of Columbia (Washington, DC) Illinois, New Jersey, New York, 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 ******************************************** 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.
    $291.9k-500.4k yearly Auto-Apply 60d+ ago
  • Audit & Reimbursement Senior

    Carebridge 3.8company rating

    Columbus, OH job

    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. National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. The Audit and Reimbursement Senior will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services). The Audit and Reimbursement Senior will support contractual workload involving complex Medicare cost reports and Medicare Part A reimbursement. This position provides a valuable opportunity to gain advanced experience in auditing and financial analysis within a growing healthcare industry. This position allows for educational opportunities leading to certifications and promotes a well-balanced lifestyle that includes professional networking opportunities. How you will make an impact: * Evaluate the work performed by other associates to ensure accurate reimbursement to providers. * Assist Audit and Reimbursement Leads and Managers in training, and development of other associates. * Participates in special projects as assigned. * Able to work independently on assignments and under minimal guidance from the manager. * Prepare detailed work papers and present findings in accordance with Government Auditing Standards (GAS) and CMS requirements. * Analyze and interpret data with recommendations based on judgment and experience. * Must be able to perform all duties of lower-level positions as directed by management. * Participate in development and maintenance of Audit & Reimbursement standard operating procedures. * Participate in workgroup initiatives to enhance quality, efficiency, and training. * Participate in all team meetings, staff meetings, and training sessions. * Assist in mentoring less experienced associates as assigned. * Prepare and perform supervisory review of cost report desk reviews and audits. * Review of complex exception requests and CMS change requests. * Perform supervisory review of workload involving complex areas of Medicare part A reimbursement such as Medicare DSH, Bad Debts, Medical Education, Nursing and Allied Health, Organ Acquisition, Wage Index and all cost based principles. Minimum Qualifications: * Requires a BA/BS and a minimum of 8 years of audit/reimbursement or related Medicare experience; or any combination of education and experience which would provide an equivalent background. * This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years. Preferred Qualifications: * Accounting degree preferred. * Knowledge of CMS program regulations and cost report format preferred. * Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred. * Must obtain Continuing Education Training requirements. * MBA, CPA, CIA or CFE preferred. * Demonstrated leadership experience preferred. * A valid driver's license and the ability to travel may be required. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $ 73,720 to $122,220 Locations: Maryland, Minnesota, Nevada and 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 ******************************************** 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.
    $73.7k-122.2k yearly Auto-Apply 60d+ ago
  • Medical Management Specialist I

    Carebridge 3.8company rating

    Columbus, OH job

    The MyCare Ohio Plan program is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. Medical Management Specialist I 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. This position will be based at any Pulse Point available in Ohio, US. 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. Schedule: This position will work an 8-hour from shift 8:00 am - 5:00 pm (EDT) Monday to Friday. Additional hours may be necessary based on company needs. The Medical Management Specialist I responsible for providing non-clinical support to the Care Coordination Team. How you will make an impact. Primary duties may include, but are not limited to: * Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review). * Provides information regarding network providers or general program information when requested. * May assist with complex cases. * Prepares reports and documents all actions. * Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. * Receive incoming member and provider calls and provide support with basic information and triage other issues to the appropriate location. * Conduct member and provider outreach to follow up on activities of care coordination. * Confirm service initiation and coordinate service delivery. * Support Care Coordinators with scheduling visits and collecting information from providers. * Help members with scheduling transportation and accessing community resources. * Facilitate exchanges of documentation between interdisciplinary teams. Minimum Requirements: * Requires a H.S. diploma or equivalent and a minimum of 1 year experience or any combination of education and experience which would provide an equivalent background. Preferred Qualifications: * Understanding of managed care or Medicaid/Medicare strongly preferred. * Call center or other phone-based customer service experience strongly preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. 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 ******************************************** 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.
    $33k-44k yearly est. Auto-Apply 60d+ ago
  • Manager I GBD Special Programs - LTSS

    Carebridge 3.8company rating

    Columbus, OH job

    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. MyCare Ohio Plan program is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. The Manager I GBD Special Programs - LTSS is responsible for managing and overseeing a team responsible for coordination of OH My Care comprehensive health care program in which Ohio dually eligible members including individuals receiving long-term services and supports (LTSS) needs are assessed for physical health, behavioral health, and social driver of health needs for older adults, LTSS populations, and Home and Community Based Services (HCBS) coordination. How You Will Make an Impact * Hires, trains, coaches, counsels, and evaluates performance of direct reports. * Adheres to the Anthem best practice model for all facets of program operations. * Collaborates with management team to support alignment across coordination teams. * Mentor direct reports to apply Independence First principles through appropriate service allocation determinations. * Ensures adequate coverage for all tasks and job responsibilities. * Coordinates service delivery of assigned team to include member assessments, care planning, and ongoing contacts. * Participates in cross-functional workgroups to maintain and enhance the program. * Evaluates current processes of Special Program's support functions; recommends changes for increased efficiencies and improved outcomes. * Identifies training needs for coordination teams. * Effectively communicates risks, status of team performance, and support needs to leadership. * Utilizes performance data to support team with consistent compliance with key program metrics. Minimum Requirements: * Requires a BA/BS and minimum of 5 years' experience in a related field, including minimum of 1 year leadership/management experience; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences: * Service delivery coordination, discharge planning or behavioral health experience in a managed care setting preferred. * Knowledge of Medicare benefits preferred. * RN, LISW, LMHC license in the State of Ohio is strongly preferred. * Service Coordination or Care Management experience is strongly preferred. * Experience with OH Waiver programs strongly preferred. * Experience supporting field based associates 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 ******************************************** 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.
    $70k-111k yearly est. Auto-Apply 60d+ ago
  • SF Case Manager Harrisonburg

    Moms In Motion 3.8company rating

    Remote or Harrisonburg, VA job

    Benefits: 401(k) Dental insurance Health insurance Training & development Vision insurance 🌟 Service Facilitator (SF) Case Manager šŸ“ Daily local travel to client homes šŸŽ“ Degree Required: Nope! ā¤ļø Make a Difference Every Day At Moms In Motion, our Service Facilitators are everyday heroes. You'll spend your days connecting with families, helping them navigate Virginia's Medicaid Waiver programs (CCC+, CL & FIS, EPSDT), and making sure those you serve can live safe, healthy, and independent lives. If you're compassionate, organized, and love the idea of making your community a better place-you'll fit right in! šŸš€ What You'll Do Hit the road (locally!) to visit clients in their homes. Be the go-to guide for families navigating waiver programs. Write up plans of care and assessments that actually make a difference. Troubleshoot challenges like service authorizations, timesheets, and more. Build lasting relationships with families built on respect, patience, and trust. Work remotely from your laptop/tablet. šŸ‘€ What We're Looking For āœ… At least 2 years of experience supporting individuals with disabilities or the elderly. āœ… No degree required (we care more about heart and experience). āœ… Tech-savvy enough for email, docs, spreadsheets, portal navigation and video calls. āœ… A valid driver's license & reliable vehicle (no client transport). āœ… Great communication-both written and spoken. āœ… Able to pass a background check + provide 2 professional references. ⭐ Bonus points if you've got Person-Centered Thinking/Planning training. šŸŽ Perks & BenefitsWe've got you covered with: Paid Training (we set you up for success!) Paid Holidays Memorial Day Juneteenth Independence Day Labor Day Columbus Day Veteran's Day Thanksgiving Day after Thanksgiving Winter Break: December 24th through January 1st 1 Floater Holiday: 8 hours to be used on any day of your choice Medical, Dental & Vision Insurance Disability, Life, and AD&D-company paid! 401K with Employer Match šŸ’° EAP & Telemedicine Access Flexible Spending Accounts & Dependent Care Options Supplemental Insurance (Accident, Cancer, Critical Care & more) Annual Tech & Auto Stipends šŸš—šŸ’» Mileage & Cell Phone Reimbursement Fun Employee Perks (discounts on car rentals, Verizon, AAA, oil changes & more!) 🌟 Compassionate. Organized. Community-focused. If that sounds like you → Apply today at ********************* We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status sexual orientation, pregnancy, childbirth or other related conditions (including lactation), age (over 40), marital status, disability or gender identity.
    $33k-44k yearly est. Auto-Apply 60d+ ago
  • Network Relations Consultant Senior (Value-Based Program Specialist) - MyCare Ohio

    Carebridge 3.8company rating

    Columbus, OH job

    Be Part of an Extraordinary Team The MyCare Ohio Plan program is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. Network Relations Consultant Senior (Value-Based Program Specialist) - MyCare Ohio Location: This position is based in Ohio; the associate will report to one of our 4 office locations below: * 3075 Vandercar Way, Cincinnati, OH 45209 * 8940 Lyra Drive, STE 300, Columbus, OH 43240 * 4361 Irwin Simpson Road, Mason, OH 45040 * 6000 Lombardo Center, STE 200, Seven Hills, OH 44131 In Office Expectation: Hybrid 1; 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. 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. Shift & Hours: Monday-Friday, 8:00 AM - 5:00 PM Eastern Time The Network Relations Consultant Senior (Value-Based Program Specialist) is responsible for and is fully dedicated to delivering on the LTSS commitment to linking provider payment to improved performance. This role will support the design and modification of Anthem VBP, based on stakeholder feedback and utilization. How You Will Make an Impact Primary duties may include, but are not limited to: * This associate will partner with Ohio Department of Medicaid (ODM), other LTSS contractors, and stakeholders to support the deployment of Value Based Payment methodologies for home and community-based services and long-term care nursing facility services, as well as to providers of other covered services, to meet provider needs and drive quality * In addition to advising on innovative programming for Anthem and supporting the VBPs, the role will be responsible for provider training, technical assistance, utilization, and performance monitoring related to the VBP offerings. * Work collaboratively with stake holders to define key VBP performance indicators and deliver accurate and timely program performance to the providers as defined by program-specific requirements. * Establish a core set of measures to be included in all provider feedback reports, standardized across all LTSS Contractors issuing the feedback reports. * May be responsible for coordinating negotiated contracts for new and existing providers as needed. * Functions as a high-level technical resource to resolve or facilitate complex provider issues. * Coordinates Joint Operation Committees (JOC) of larger provider groups, driving the meetings in the discussion of issues and changes. * Identifies and reports on provider utilization patterns which have a direct impact on quality-of-service delivery. * Tracks and conduct provider refresher training as needed. * Researches issues that may impact future provider negotiations or jeopardize network retention. * Travels to worksite and other locations, as necessary. Minimum Requirements: * Requires a Bachelor's degree and a minimum of 5 years of customer service experience including 2 years' experience as a Network Management Representative; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities, & Experiences: * Prior experience as an LTSS or HCBS provider or in a provider office is preferred. * Experience training or mentoring preferred. * Value Based contracting/payment concepts experience preferred. * Provider education experience preferred. * Experience presenting to various levels of leadership strongly 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 ******************************************** 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.
    $88k-115k yearly est. Auto-Apply 60d+ ago
  • Pharmacy Benefits Manager Pricing Strategy Analyst Manager

    Carebridge 3.8company rating

    Columbus, OH job

    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. 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 PBM Pricing Strategy Analyst Manager is responsible for Pharmacy Services pricing and Administrative Services Only (ASO) support functions. How You Will Make an Impact Primary duties may include, but are not limited to: * Implements new processes, process improvements, and best practices related to pricing, guarantee monitoring, and ASO pass back activities. * Creates and implements metrics and supports performance measures to establish performance objectives for revenue maximization and pharmacy pricing. * Creates tools and processes to monitor margin revenue, pricing accuracy, and client retention. * Monitors revenue performing below thresholds and implements necessary tasks to bring performance to or above targets. * Implements pricing in the system related to margin. * Supports the Pharmacy Services team in implementing future revenue, member expansion and growth capacity. * Assists with developing pharmacy pricing training to underwriters and updates to underwriting guidelines. Minimum Requirements: Requires a BA/BS in Finance or related field and a minimum of 5 years of experience with a Pharmacy Benefits Manager (PBM), pricing, data analysis; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: MBA strongly 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 ******************************************** 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.
    $84k-120k yearly est. Auto-Apply 60d+ ago
  • Housing Outreach Specialist

    Carebridge 3.8company rating

    Columbus, OH job

    Location : Candidate must reside in the state of Ohio. 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. Possible travel within the state of Ohio when needed. 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 Housing Outreach Specialist is responsible for developing and implementing the health plans housing strategy and programs. This includes the approach to assisting individuals in programs in securing accessible, affordable housing through Federal and local programs. The Specialist will possess knowledge of housing programs and services, focusing on homelessness and at-risk populations, and specific accessibility needs as related to LTSS populations. How you will make an impact : * Liaise between housing agencies and the health plan and partner with these agencies to develop and access affordable housing services for members. * Partner with the Health Plan trainers to develop and implement training specific to affordable housing services in the state of Ohio. * Work under the Housing First model, honoring Member choice. * Responsible for working with housing agencies and other housing programs to help develop and access affordable housing services for Members receiving LTSS. * Responsible for education and supporting Care Coordinators and Support Coordinators in identifying housing options for members. Minimum Requirements : * Requires a minimum of 3 years experience in developing housing and/or housing policy at a local, state or federal level for special populations such as the elderly, people with disability and/or people with mental health challenges to secure accessible, affordable housing through Federal and local programs; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities & Experiences : * Bachelor's degree in Social Services or related field highly preferred. * Case management experience with older adults or individuals with disabilities. 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 ******************************************** 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.
    $32k-43k yearly est. Auto-Apply 60d+ ago
  • Director II Medical Cost Intelligence AI & Engineering

    Carebridge 3.8company rating

    Columbus, OH job

    Director II Medical Cost Intelligence AI & Engineering (Dir II Engineering) Location: This role requires associates to be in-office 3 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. 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. Alternate locations may be considered if candidate resides within a commutable distance from an office. The Director II Medical Cost Intelligence AI & Engineering is responsible for strategic oversight and delivery of enterprise technology solutions, inclusive of AI, analytics and agentic solutions, business units and enterprise functions focused on managing medical cost. Delivery responsibilities will include leading engineering teams and collaborating with internal technology teams to deliver scalable enterprise level solutions that will proactively manage medical costs through the use of AI & analytics focused capabilities to drive affordable healthcare across the industry. The role will also be responsible for drive innovation technology solutions that change the strategic landscape of how Elevance Health manages medical costs and proactively identifies and takes actions to ensure affordable healthcare. How you will make an impact: * Planning, directing, and controlling multiple teams of resources and initiatives to accomplish the objectives and requirements defined by senior technology and product management across multiple teams. This is inclusive of design, development, and testing teams delivering AI & analytics solutions. * Provides technology thought leadership to business partners ensuring teams are delivering scalable solutions that enable enterprise level priorities and financial goals. * Responsible for the planning and execution of technology solutions and the ability to manage to budgetary constraints. * Interfaces with key technology solution vendors; develops strategies and facilitates performance measurement plans to optimize vendor and associate performance and outcomes. * Develops application technology plans, forecasting for an enterprise application, enterprise-wide tool, infrastructure, or a center or domain that is equivalent in scope and complexity. * Manages a domain or suite of applications (or the equivalent capital and/or level of responsibility). * Oversees strategic planning, budget development, and management for a single large or multiple cost centers, contract compliance, and any necessary integration of government regulatory requirements. * Ensures disaster recovery and business continuity plan are implemented, monitored, and updated on a recurring basis. * Ensures delivery and supports system solutions that support the continuous operations. * Identifies and resolves hurdles for assigned areas/groups according to established deadlines. * Establishes and maintains collaborative relationships with key business partners. * Partners with customers in order to understand new product enhancements or features being requested. * Plans and executes annual projects while maintaining profit and loss (P&L) responsibility. * Establishes and maintains collaborative relationships with key business partners. * Hires, trains, coaches, counsels, and evaluates performance of direct reports. Minimum Requirements: Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 8 years of IT management experience in the area of function being managed; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences: * Health insurance industry experience, specifically at a provider or payer strongly preferred. * AI delivery of business solutions strongly preferred. * Experience delivering AI and technology solutions for a targeted business function strongly preferred. * Prior people leadership experience preferred. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. Please Note: If this is not a straight backfill, please consult with your HR Business Partner prior to posting/using this job. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $199,936 to $327,168. Locations: California, District of Columbia (Washington DC), Illinois, 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 ******************************************** 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.
    $108k-153k yearly est. Auto-Apply 60d+ ago
  • Compliance Manager

    Carebridge 3.8company rating

    Columbus, OH job

    Location: This role requires associates to be in-office 1 - 2 days per week at one of our four Ohio offices (Cincinnati, Columbus, Mason, Seven Hills) 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. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location will not be considered for employment, unless an accommodation is granted as required by law. The Compliance Manager is responsible for managing foundational and strategic compliance responsibilities with consistent excellence that support the team and management. How You Will Make an Impact * Manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness. * Establish project plans, gap analysis, milestone dates, and other significant aspects, and leadership updates. * Maintain knowledge of laws, regulations, company strategies to assess impact, and consult with clients as subject matter expert. * Conducts complex investigations, document findings, and ensure corrective actions are made. * Interface with external clients, regulators, vendors, supplier; internal stakeholders, high level of management. Minimum Requirements * Requires a BA/BS and minimum of 6 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences * Experience with Medicaid, Medicare or Dual Special Needs Plans highly preferred. * Ability to travel may be required. * MS/MBA/JD or professional designation 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 ******************************************** 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.
    $72k-102k yearly est. Auto-Apply 60d+ ago
  • Manager Behavioral Health Services

    Carebridge 3.8company rating

    Columbus, OH job

    JR167272 Manager Behavioral Health Services Responsible for overseeing Behavioral Health Utilization Management (BH UM), this position supports the Medicaid line of business. Location: Hybrid 2: This role requires associates to be in-office 3 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. How will you make an impact: * Serves as a resource for medical management programs. Identifies and recommends revisions to policies/procedures. * Ensures staff adheres to accreditation guidelines. * Supports quality improvement activities. * May assist with implementation of cost of care initiatives. * May attend meetings to review UM and/or CM process and discusses facility issues. * Hires, trains, coaches, counsels, and evaluates performance of direct reports. * Responsibilities for BH UM may include: Manages a team of licensed clinicians and non-clinical support staff responsible to ensure medical necessity and appropriateness of care for inpatient/outpatient BH services; ensures appropriate utilization of BH services through level of care determination, accurate interpretation/application of benefits, corporate medical policy and cost efficient, high quality care; manages consultation with facilities and providers to discuss plan benefits and alternative services; manages case consultation and education to customers and internal staff for efficient utilization of BH services; leads development and maintenance of positive relationship with providers and works to ensure quality outcomes and cost effective care; assists in developing clinical guidelines and medical policies used in performing medical necessity reviews; provides leadership in the development of new pilots and initiatives to improve care or lower cost of care. Minimum requirements: LICENSURE REQUIREMENTS FOR ALL FUNCTIONS: * Requires current, active, unrestricted license such as LCSW (as applicable by state law and scope of practice), LMHC, LPC, LMSW (as allowed by applicable state laws), LMFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States. * For Government business only: LAPC, and LAMFT are also acceptable if allowed by applicable state laws and any other state or federal requirements that may apply; provided that the manager's director has one of the types of licensures specified in the preceding sentence. * Licensure is a requirement for this position. EDUCATION/EXPERIENCE REQUIREMENTS: * Prior experience in Managed Care setting required. * Additional requirements for BH UM: MS in social work, counseling, psychology or related behavioral health field or a degree in nursing and minimum of 5 years of clinical experience with facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of education and experience, which would provide an equivalent background. * Experience applying clinical and policy knowledge on the continuum of Behavioral Health treatment strongly preferred. Preferred Skills, Capabilities, and Experiences: * Leadership and prior management experience. * Experience in managed care. * Candidates from all states are welcome, but they must reside within commuting distance of a Pulse Point office location where we have an office to be considered. * Proficiency in MS Office and data reporting. 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 ******************************************** 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.
    $65k-84k yearly est. Auto-Apply 60d+ ago
  • Medical Mgmt Specialist I

    Carebridge 3.8company rating

    Remote or Washington, DC job

    Medical Management Specialist I Location: Washington, DC. This role requires associates to be in-office 4 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 remote work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. 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. Schedule: Monday-Friday 8:00AM-5:00PM or 8:30AM-5:30PM EST The Medical Management Specialist I will be responsible for providing non-clinical support to the Medical Management and/or Operations areas. How you will make an impact: * Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review). * Provides information regarding network providers or general program information when requested. * May assist with complex cases. * May act as liaison between Medical Management and/or Operations and internal departments. * Maintains and updates tracking databases. * Prepares reports and documents all actions. * Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Minimum Requirements: * Requires a H.S. diploma or equivalent and a minimum of 1 year experience or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities & Experiences: * Understanding of managed care or Medicaid/Medicare strongly preferred. For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $23.46/hr - $35.19/hr. Locations: District of Columbia (Washington, DC) 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 ******************************************** 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.
    $23.5-35.2 hourly Auto-Apply 60d+ ago
  • SF Case Manager Springfield / Burke

    Moms In Motion 3.8company rating

    Remote or Springfield, VA job

    Benefits: 401(k) Dental insurance Health insurance Training & development Vision insurance 🌟 Service Facilitator (SF) Case Manager šŸ“ Daily local travel to client homes šŸŽ“ Degree Required: Nope! ā¤ļø Make a Difference Every Day At Moms In Motion, our Service Facilitators are everyday heroes. You'll spend your days connecting with families, helping them navigate Virginia's Medicaid Waiver programs (CCC+, CL & FIS, EPSDT), and making sure those you serve can live safe, healthy, and independent lives. If you're compassionate, organized, and love the idea of making your community a better place-you'll fit right in! šŸš€ What You'll Do Hit the road (locally!) to visit clients in their homes. Be the go-to guide for families navigating waiver programs. Write up plans of care and assessments that actually make a difference. Troubleshoot challenges like service authorizations, timesheets, and more. Build lasting relationships with families built on respect, patience, and trust. Work remotely from your laptop/tablet. šŸ‘€ What We're Looking For āœ… At least 2 years of experience supporting individuals with disabilities or the elderly. āœ… No degree required (we care more about heart and experience). āœ… Tech-savvy enough for email, docs, spreadsheets, portal navigation and video calls. āœ… A valid driver's license & reliable vehicle (no client transport). āœ… Great communication-both written and spoken. āœ… Able to pass a background check + provide 2 professional references. ⭐ Bonus points if you've got Person-Centered Thinking/Planning training. šŸŽ Perks & BenefitsWe've got you covered with: Paid Training (we set you up for success!) 11 Paid Holidays šŸŽ‰ Medical, Dental & Vision Insurance Disability, Life, and AD&D-company paid! 401K with Employer Match šŸ’° EAP & Telemedicine Access Flexible Spending Accounts & Dependent Care Options Supplemental Insurance (Accident, Cancer, Critical Care & more) Annual Tech & Auto Stipends šŸš—šŸ’» Mileage & Cell Phone Reimbursement Fun Employee Perks (discounts on car rentals, Verizon, AAA, oil changes & more!) 🌟 Compassionate. Organized. Community-focused. If that sounds like you → Apply today at ********************* We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status sexual orientation, pregnancy, childbirth or other related conditions (including lactation), age (over 40), marital status, disability or gender identity.
    $34k-45k yearly est. Auto-Apply 60d+ ago
  • Change Management Project Manager

    Moms In Motion 3.8company rating

    Remote or Front Royal, VA job

    Benefits: 401(k) Health insurance Paid time off Training & development Vision insurance 🌟 Change Management Project Manager šŸ“ Remote (MUST live in Virginia) šŸ•˜ Full-Time | Monday-Friday | 8AM-5PM | Exempt At Moms In Motion, we are passionate about strengthening our teams, improving our systems, and ensuring families receive the highest-quality support possible. We're looking for a Change Management Project Manager who can lead organizational change with clarity, consistency, and heart. This role is perfect for someone who thrives in a fast-paced environment, communicates exceptionally well, and knows how to guide teams through new processes and transitions with confidence. šŸš€ What You'll Do Develop and implement effective change management strategies and project plans Manage end-to-end project activities, timelines, scope, and risk Partner with cross-functional teams-Operations, HR, Training, IT, and Leadership-to drive successful adoption Create clear communication materials, project documentation, and leadership updates Facilitate meetings, gather feedback, and support stakeholder engagement Work closely with the Training Manager to ensure staff training aligns with organizational change Analyze organizational impacts and recommend practical solutions Track project performance, adoption metrics, and readiness indicators Provide ongoing guidance on change management best practices and methodologies šŸ‘€ What We're Looking For āœ… Experience leading organizational change or major process initiatives āœ… Strong project planning, organization, and process management skills āœ… Excellent communication abilities and comfort working with multiple departments āœ… Analytical mindset and strong problem-solving skills āœ… Experience with project management, workflow, or business analysis tools āœ… Familiarity with change management models (ADKAR, Kotter, etc.) āœ… Ability to adapt quickly in a dynamic environment ⭐ Preferred Qualifications Project Management certification (PMP, CAPM, or similar) IT Business Analyst experience Knowledge of Virginia Medicaid CD Waivers šŸŽ Perks & BenefitsWe've got you covered with: Paid Training (we set you up for success!) PTO Paid Holidays Memorial Day Juneteenth Independence Day Labor Day Columbus Day Veteran's Day Thanksgiving Day after Thanksgiving Winter Break: December 24th through January 1st 1 Floater Holiday: 8 hours to be used on any day of your choice Medical, Dental & Vision Insurance Disability, Life, and AD&D-company paid! 401K with Employer Match šŸ’° EAP & Telemedicine Access Flexible Spending Accounts & Dependent Care Options Supplemental Insurance (Accident, Cancer, Critical Care & more) Annual Tech Stipends šŸ’» Cell Phone Reimbursement Fun Employee Perks (discounts on car rentals, Verizon, AAA, oil changes & more!) 🌟 Compassionate. Organized. Community-focused. If that sounds like you → Apply today at ********************* This is a remote position. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status sexual orientation, pregnancy, childbirth or other related conditions (including lactation), age (over 40), marital status, disability or gender identity.
    $74k-107k yearly est. Auto-Apply 52d ago
  • Medical Cost AI Intelligence Director

    Carebridge 3.8company rating

    Columbus, OH job

    Medical Cost AI Intelligence Director (IT Strategy & Planning Director) Location: This role requires associates to be in-office 3 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. 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. Alternate locations may be considered if candidate resides within a commutable distance from an office. The Medical Cost AI Intelligence Director is responsible for strategy, planning and execution of technology solutions to proactively manage medical costs through the use of AI & analytics focused capabilities to drive affordable healthcare across the industry. The role will also be responsible for comprehensively looking at the provider and payer landscape to identify and drive innovative approaches for understanding medical cost trends, provider behavior, provider billing behavior, and healthcare industry operations to streamline medical costs for health plan members. How you will make an impact: * Develop and execute overall technology, inclusive of AI & analytics, strategies at the enterprise level driving alignment across various business unites to ensure enterprise financial goals & priorities are enables by technology delivery. * Partners with senior planning leaders and executive leadership to create sound multi year plans with clear planning assumptions and accurate financial insights for the technology function. * Monitors and conducts research of related technology and business trends, using data and qualitative performance measures, to advise senior management relative to IT strategy. * Synthesizes annual and multi-year plans to demonstrate tie-back to corporate and senior leadership-level strategies and goals. * Conduct external research and engage partners across multiple departments within the broader enterprise to frame up potential strategic initiatives for investment or execution support. * Use forecast models and scenario analysis to analyze performance and develop action plans to address emerging market and technological opportunities. * Researches new ventures and prospective service expansion opportunities. Create executive reports that decipher complex technical issues. Minimum Requirements: Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 10 years experience in Data Collection and Analysis, IT Consulting, IT Performance Management, Strategy or Financial Planning, Business Intelligence and Analytics, or Business Process Design; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences: * Healthcare experience within the provider systems, healthcare insurers , or services companies that support providers systems or healthcare insurers strongly preferred. * Experience implementing analytics solutions including use of advance AI/ML techniques strongly preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $178,200 to $291,600. Locations: California, District of Columbia (Washington DC), Illinois, 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 ******************************************** 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.
    $178.2k-291.6k yearly Auto-Apply 60d+ ago
  • SF Case Manager Franklin, Henry and Martinsville

    Moms In Motion 3.8company rating

    Remote or Franklin, VA job

    Benefits: 401(k) matching Dental insurance Health insurance Training & development Vision insurance 🌟 Service Facilitator (SF) Case Manager šŸ“ Daily local travel to client homes šŸŽ“ Degree Required: Nope! ā¤ļø Make a Difference Every Day At Moms In Motion, our Service Facilitators are everyday heroes. You'll spend your days connecting with families, helping them navigate Virginia's Medicaid Waiver programs (CCC+, CL & FIS, EPSDT), and making sure those you serve can live safe, healthy, and independent lives. If you're compassionate, organized, and love the idea of making your community a better place-you'll fit right in! šŸš€ What You'll Do Hit the road (locally!) to visit clients in their homes. Be the go-to guide for families navigating waiver programs. Write up plans of care and assessments that actually make a difference. Troubleshoot challenges like service authorizations, timesheets, and more. Build lasting relationships with families built on respect, patience, and trust. Work remotely from your laptop/tablet. šŸ‘€ What We're Looking For āœ… At least 2 years of experience supporting individuals with disabilities or the elderly. āœ… No degree required (we care more about heart and experience). āœ… Tech-savvy enough for email, docs, spreadsheets, portal navigation and video calls. āœ… A valid driver's license & reliable vehicle (no client transport). āœ… Great communication-both written and spoken. āœ… Able to pass a background check + provide 2 professional references. ⭐ Bonus points if you've got Person-Centered Thinking/Planning training. šŸŽ Perks & BenefitsWe've got you covered with: Paid Training (we set you up for success!) Paid Holidays Memorial Day Juneteenth Independence Day Labor Day Columbus Day Veteran's Day Thanksgiving Day after Thanksgiving Winter Break: December 24th through January 1st 1 Floater Holiday: 8 hours to be used on any day of your choice Medical, Dental & Vision Insurance Disability, Life, and AD&D-company paid! 401K with Employer Match šŸ’° EAP & Telemedicine Access Flexible Spending Accounts & Dependent Care Options Supplemental Insurance (Accident, Cancer, Critical Care & more) Annual Tech & Auto Stipends šŸš—šŸ’» Mileage & Cell Phone Reimbursement Fun Employee Perks (discounts on car rentals, Verizon, AAA, oil changes & more!) 🌟 Compassionate. Organized. Community-focused. If that sounds like you → Apply today at ********************* We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status sexual orientation, pregnancy, childbirth or other related conditions (including lactation), age (over 40), marital status, disability or gender identity.
    $34k-44k yearly est. Auto-Apply 24d ago
  • Change Management Project Manager

    Moms In Motion 3.8company rating

    Remote or Front Royal, VA job

    Job DescriptionBenefits: 401(k) Health insurance Paid time off Training & development Vision insurance Change Management Project Manager Remote (MUST live in Virginia) Full-Time | MondayFriday | 8AM5PM | Exempt At Moms In Motion, we are passionate about strengthening our teams, improving our systems, and ensuring families receive the highest-quality support possible. Were looking for a Change Management Project Manager who can lead organizational change with clarity, consistency, and heart. This role is perfect for someone who thrives in a fast-paced environment, communicates exceptionally well, and knows how to guide teams through new processes and transitions with confidence. What Youll Do Develop and implement effective change management strategies and project plans Manage end-to-end project activities, timelines, scope, and risk Partner with cross-functional teams Operations, HR, Training, IT, and Leadershipto drive successful adoption Create clear communication materials, project documentation, and leadership updates Facilitate meetings, gather feedback, and support stakeholder engagement Work closely with the Training Manager to ensure staff training aligns with organizational change Analyze organizational impacts and recommend practical solutions Track project performance, adoption metrics, and readiness indicators Provide ongoing guidance on change management best practices and methodologies What Were Looking For Experience leading organizational change or major process initiatives Strong project planning, organization, and process management skills Excellent communication abilities and comfort working with multiple departments Analytical mindset and strong problem-solving skills Experience with project management, workflow, or business analysis tools Familiarity with change management models (ADKAR, Kotter, etc.) Ability to adapt quickly in a dynamic environment Preferred Qualifications Project Management certification (PMP, CAPM, or similar) IT Business Analyst experience Knowledge of Virginia Medicaid CD Waivers Perks & Benefits Weve got you covered with: Paid Training (we set you up for success!) PTO Paid Holidays Memorial Day Juneteenth Independence Day Labor Day Columbus Day Veteran's Day Thanksgiving Day after Thanksgiving Winter Break: December 24th through January 1st 1 Floater Holiday: 8 hours to be used on any day of your choice Medical, Dental & Vision Insurance Disability, Life, and AD&Dcompany paid! 401K with Employer Match EAP & Telemedicine Access Flexible Spending Accounts & Dependent Care Options Supplemental Insurance (Accident, Cancer, Critical Care & more) Annual Tech Stipends Cell Phone Reimbursement Fun Employee Perks (discounts on car rentals, Verizon, AAA, oil changes & more!) Compassionate. Organized. Community-focused. If that sounds like you Apply today at ********************* This is a remote position.
    $74k-107k yearly est. 23d ago

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CareFinders Total Care may also be known as or be related to Care Finders Inc, Care Finders Total Care, Care Finders Total Care LLC and CareFinders Total Care.