Plano, Texas, United States · Hybrid
Anticipated End Date: 2026-07-16 Position Title: Referral Specialist II - Paragon Infusion Centers Job Description: Referral Specialist II - Paragon Infusion Centers Location: TX-PLANO, 3033 W PRESIDENT GEORGE BUSH HWY, …
Skills: Medical Terminology, ICD Coding, CPT Coding, Insurance Verification, Authorization Processing
Miami, Florida, United States · Remote OK
Anticipated End Date: 2026-07-15 Position Title: Prior Authorization Clinical Pharmacist Job Description: Prior Authorization Clinical Pharmacist Virtual: This role enables associates to work virtually full-time, with th…
Skills: Prior Authorization, Drug Utilization Review, Formulary Management, Clinical Data Synthesis, Drug Monograph Preparation
Baltimore, Maryland, United States · Hybrid
$116k–$173k/yr
Anticipated End Date: 2026-08-28 Position Title: Field Advanced Practice Provider Job Description: Location: This field-based role enables associates to primarily operate in the field, traveling to client sites or design…
Skills: Palliative Care, Clinical Care Planning, Patient Education, Physical Examination, Medication Prescription
Atlanta, Georgia, United States · Hybrid
$84k–$132k/yr
Anticipated End Date: 2026-07-17 Position Title: Med Mgmt Nurse Job Description: Medical Management Nurse Hours: Tuesday-Saturday 830am-5pm EST Location: This role enables associates to work virtually full-time, with the…
Skills: Nursing Judgment, Critical Thinking, Holistic Assessment, Medical Necessity Review, Utilization Management
Ashburn, Virginia, United States · Hybrid
$105k–$190k/yr
Anticipated End Date: 2026-08-28 Position Title: Field Advanced Practice Provider Job Description: Location: This field-based role enables associates to primarily operate in the field, traveling to client sites or design…
Skills: Palliative Care, Clinical Care Planning, Patient Education, Physical Examination, Medication Prescription
Miami, Florida, United States · Hybrid
Anticipated End Date: 2026-07-17 Position Title: Medical Management Nurse - Florida Job Description: Medical Management Nurse Hours: Monday - Friday 8am to 5pm EST or 4/10s Saturday-Tuesday 7AM-6PM ESTWill be required to…
Skills: Nursing Judgment, Critical Thinking, Holistic Assessment, Medical Necessity Review, Utilization Review
Lake Mary, Florida, United States · Hybrid
Anticipated End Date: 2026-08-28 Position Title: Pharmacy Technician III Job Description: Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while provi…
Skills: Specialty Pharmacy Operations, Prior Authorization Processing, Data Entry, Case Management, Grievance and Appeals Resolution
Tampa, Florida, United States · Hybrid
Anticipated End Date: 2026-07-23 Position Title: DevSecOps Engineer - Information Security Job Description: DevSecOps Engineer - Information Security Location: This role requires associates to be in-office 1 - 2 days per…
Skills: DevSecOps, Application Security, Cloud Security, Vulnerability Management, CI/CD Pipelines
Atlanta, Georgia, United States · Hybrid
Anticipated End Date: 2026-07-17 Position Title: Associate Actuary (Medicare Pharmacy Trend Analytics) - CarelonRx Job Description: Associate Actuary (Medicare Pharmacy Trend Analytics) - CarelonRx Hybrid: This role requ…
Skills: Actuarial Analysis, Medicare Part B, Medicare Part D, Pharmacy Trend Analytics, Financial Forecasting
Latham, New York, United States · Remote OK
$28/hr–$42/hr
Anticipated End Date: 2026-07-17 Position Title: Medical Management Clinician Associate Job Description: The Medical Management Clinician Associate is responsible for ensuring appropriate, consistent administration of pl…
Skills: Clinical Review, Medical Necessity Assessment, Utilization Review, Benefit Plan Administration, Clinical Guidelines Application
Atlanta, Georgia, United States · Hybrid
Anticipated End Date: 2026-08-24 Position Title: Database Admin Advisor Job Description: Database Admin Advisor Location: Ideal candidates will be able to report to our Pulse Point location at 740 W Peachtree St NW, Atla…
Skills: Snowflake Database Administration, Snowsight, Python, SPL, Snowflake SQL
Winston-Salem, North Carolina, United States · Hybrid
Anticipated End Date: 2026-08-24 Position Title: Systems Performance Engineer Senior Job Description: Systems Performance Engineer Senior Location: Ideal candidates will be able to report to our Pulse Point location at 5…
Skills: Performance Engineering, LoadRunner, AppDynamics, Splunk, Wily
Mason, Ohio, United States · Hybrid
Anticipated End Date: 2026-08-24 Position Title: Engineer III Job Description: Engineer III Location: Ideal candidates will be able to report to our Pulse Point location at 4361 Irwin Simpson Road, Mason, OH 45040. This …
Skills: Python, AWS, CloudFormation, Terraform, Agile
Iloilo City, Western Visayas, Philippines · On-site
Position Title: Mgr Performance Enhancement (PHL) Shift: Job Description:
Skills: Performance Enhancement, Contact Center Operations, Clinical Nurse Operations, Healthcare Operations, Data Analysis
Taguig, Metro Manila, Philippines · On-site
Position Title: Systems Analyst I (PHL) Shift: 9:00 PM to 6:00AM (Philippines) Job Description: Provides Level 1–2 support for assigned business applications/systems (triage, troubleshoot, resolve, or escalate).Monitors …
Skills: Level 1-2 Support, System Administration, Problem Management, ITSM Tools, UAT Support
Miami, Florida, United States · Hybrid
Anticipated End Date: 2026-07-17 Position Title: Medical Management Clinician Associate Job Description: Medical Management Clinician Associate Location: Candidates are required to reside in the state of Florida. This ro…
Skills: Utilization Review, Clinical Assessment, Medical Necessity Review, Precertification, Concurrent Review
Boston, Massachusetts, United States · Hybrid
$21/hr–$36/hr
Anticipated End Date: 2026-07-17 Position Title: Wellness & Recovery Specialist - Massachusetts Job Description: Wellness & Recovery Specialist - Massachusetts Location: Virtual: This role enables associate to work virtu…
Skills: Care Coordination, Case Management, Psychiatric Discharge Planning, Crisis Line Management, Member Advocacy
Tampa, Florida, United States · Hybrid
Anticipated End Date: 2026-07-14 Position Title: Social Work Case Manager Job Description: Social Work Case Manager Location: This role enables associates to work virtually full-time, with the exception of required in-pe…
Skills: Case Management, Psychosocial Intervention, Chronic Illness Management, Behavioral Health Coordination, Resource Allocation
Denver, Colorado, United States · Hybrid
$62k–$93k/yr
Anticipated End Date: 2026-07-17 Position Title: Documentation Analyst Senior (Information Mapping) Job Description: Documentation Analyst Senior (Information Mapping) Hybrid 1: This role requires associates to be in-off…
Skills: Information Mapping, Process Mapping, Performance Support, Technical Documentation, Data Validation
Atlanta, Georgia, United States · Hybrid
$94k–$156k/yr
Anticipated End Date: 2026-07-14 Position Title: Agile Product Owner - Oncology Job Description: Agile Product Owner – Oncology Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering colla…
Skills: Agile Methodology, Product Ownership, Backlog Management, User Story Writing, Stakeholder Management
Plano, Texas, United States • Hybrid
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Acts as a liaison between healthcare providers, patients, and insurance plans to facilitate clinical referrals. Responsible for reviewing complex referrals, verifying insurance coverage, and documenting all communications in the system.
Requires a high school diploma or GED and at least one year of experience in a high-volume healthcare customer service or call center environment. Preferred qualifications include knowledge of medical coding and experience with NextGen software.
Location: TX-PLANO, 3033 W PRESIDENT GEORGE BUSH HWY, STE 100
Shift: 8:00 am - 5:00 pm CT.
Hybrid: 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.
Onsite Days: Tuesday, Wednesday, Thursday
The Referral Specialist II - Paragon Infusion Centers is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals.
Acts as liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
Reviews complex referrals for completeness and follows up for additional information if necessary.
Assigns referrals to staff as appropriate.
Verifies insurance coverage and obtains authorizations if needed from insurance plans.
Contacts physician offices as needed to obtain demographic information or related data.
Enters referrals, documents communications and actions in system.
Enters referrals, documents communications, actions and other data in system.
Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment.
Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
Performs other duties as assigned.
Requires HS diploma or GED and a minimum of 1 year of experience in a high-volume, interactive customer service or call center in a healthcare environment; or any combination of education and experience which would provide an equivalent background.
Knowledge of medical terminology, plan specific guidelines; ICD and CPT coding.
Experience with healthcare benefit referrals, authorizations, appeals, and cost estimates.
Healthcare Commercial and Government experience.
NextGen experience.
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.
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.
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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
