Senior Behavioral Health Appeals Coordinator (Hybrid)

Elevance Health; Columbus (OH); Híbrido; USD 73.000 - 110.000; Jornada completa

Descripción de la vacante

Elevance Health seeks a Behavioral Health Appeals Coordinator Senior to investigate and process the most complex grievances and appeals from members and providers related to behavioral health services. This role offers hybrid work options and the chance to serve as a technical resource on medical policy initiatives.

Ideal candidates hold an MS in social work or RN, with 4+ years in managed care/healthcare and active unrestricted licenses (LCSW/LMFT/LP C/RN).

Formación

• MS in social work, RN or related behavioral health field.
• Current active unrestricted license as a Licensed Clinical Social Worker, Marriage and Family Therapist, Clinical Psychologist, Licensed Professional Counselor or RN license to practice as a health care professional within scope of licensure in applicable state(s).
• Minimum of 4 years of experience in a managed care/healthcare setting.

Responsabilidades

• Investigates and reviews member and provider grievances and appeals.
• Works on complex issues.
• Acts as internal resource for lower-level behavioral health appeal coordinators and staff.
• Reviews prospective, inpatient, or retrospective medical records for medical necessity.
• Summarizes medical information for medical director and external review.
• Prepares recommendations to uphold or deny appeal for medical director approval.
• Ensures timely resolution to meet regulatory timeframes.
• Documents and logs information on tracking systems.

Educación

MS in social work

RN or related behavioral health field degree

Active unrestricted licenses (LCSW, LMFT, Clinical Psychologist, LPC, or RN)

Descripción del empleo

Elevance Health seeks a Behavioral Health Appeals Coordinator Senior to investigate and process the most complex grievances and appeals from members and providers related to behavioral health services. This role offers hybrid work options and the chance to serve as a technical resource on medical policy initiatives.

Ideal candidates hold an MS in social work or RN, with 4+ years in managed care/healthcare and active unrestricted licenses (LCSW/LMFT/LP C/RN).