Prior to Telstra Health, Elizabeth was Secretary of New South Wales (NSW) Health for a six-year term. As Secretary, Elizabeth was responsible for the management of the NSW health system, the largest health system in Australia with a $30 billion budget and 124,000 full time equivalent staff.

Key strategic achievements include the implementation of value-based care across NSW, the progression of eHealth initiatives and a $2 billion per year capital infrastructure program.

In 2020-21, Elizabeth led the NSW Health system through the COVID-19 pandemic and advised NSW crisis cabinet on the management of coronavirus in NSW and the subsequent vaccine roll-out.

Elizabeth was chair of the Australian Health Ministers Advisory Council (AHMAC) and its subsequent iteration of Health Chief Executives Forum, and is a Member of the Order of Australia.