Senior Behavioral Health Appeals Coordinator — Remote (OH)

Elevance Health; United States; Híbrido; USD 73.000 - 110.000; Jornada completa

Descripción de la vacante

Elevance Health is seeking a Behavioral Health Appeals Coordinator Senior (BCBA & Ohio BH Licensed) in Ohio. This role handles complex grievances and appeals from members and providers, serving as a technical resource for the team.

You will review medical records for medical necessity, prepare recommendations for medical director approval, and ensure timely resolution within regulatory timeframes. The position offers hybrid/virtual options with required in-person training sessions.

Formación

• Requires MS in social work, RN or degree in a related behavioral health field with license.
• Active, unrestricted license to practice in applicable state(s) or territory.
• 4+ years in a managed care/healthcare setting or equivalent background.

Responsabilidades

• Investigates and reviews member and provider grievances and appeals.
• Reviews medical records for medical necessity.
• Prepares recommendations and forwards to medical director for approval.
• Ensures timely resolution to meet regulatory timeframes.
• Documents information on tracking systems and mainframe systems.
• Participates in projects impacting medical policy or managed care initiatives.

Conocimientos

BCBA

Appeals Reviewer

ASD experience

Educación

MS in social work / RN or related behavioral health field

Descripción del empleo

Elevance Health is seeking a Behavioral Health Appeals Coordinator Senior (BCBA & Ohio BH Licensed) in Ohio. This role handles complex grievances and appeals from members and providers, serving as a technical resource for the team.

You will review medical records for medical necessity, prepare recommendations for medical director approval, and ensure timely resolution within regulatory timeframes. The position offers hybrid/virtual options with required in-person training sessions.