Senior BCBA Health Appeals Coordinator (Hybrid)

Elevance Health, Inc.; Oregon; Hybrid; USD 90,000 - 120,000; Full time

Job summary

Elevance Health is seeking a Senior Behavioral Health Appeals Coordinator (BCBA) to join our collaborative team in a hybrid arrangement. The role emphasizes complex grievances, medical necessity reviews, and preparing recommendations for appeals, with in-office time 1–2 days weekly.

Candidates will need an MS in social work or related behavioral health field, plus 4+ years in managed care; a current BCBA is preferred.

Qualifications

• Requires MS in social work, RN or degree in a related behavioral health field, with minimum 4 years in a managed care/healthcare setting.
• Current active unrestricted license as a Licensed Clinical Social Worker, Marriage and Family Therapist, Clinical Psychologist, Licensed Professional Counselor or RN to practice within applicable states.

Responsibilities

• Investigates and reviews member and provider grievances and appeals.
• Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
• Prepares recommendations to uphold or deny appeal and forwards to medical director for approval.
• Documents and logs information on tracking systems and mainframe systems.
• Participates in projects impacting development, interpretation, and implementation of medical policy or other managed care initiatives.

Skills

BCBA

Appeals Reviewer

ASD experience

Education

MS in social work

RN license

Behavioral health degree

Job description

Elevance Health is seeking a Senior Behavioral Health Appeals Coordinator (BCBA) to join our collaborative team in a hybrid arrangement. The role emphasizes complex grievances, medical necessity reviews, and preparing recommendations for appeals, with in-office time 1–2 days weekly.

Candidates will need an MS in social work or related behavioral health field, plus 4+ years in managed care; a current BCBA is preferred.