Behavioral Health Appeals Coordinator Sr

Location This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development. The position will be based in California, Colorado, and Nevada. Note: As 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. Schedule This position will work an 8‑hour shift from 8:00 am – 5:00 pm (PDT) Monday to Friday. Additional hours may be necessary based on company needs. Responsibilities Investigates and reviews member and provider grievances and appeals. Generally works on issues that are of a complex nature. Serves as an internal resource for lower level behavioral health appeal coordinators and staff. Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity. Extrapolates and summarizes medical information for medical director, consultants and other external review. Prepares recommendations to either uphold or deny appeal and forwards to medical director for approval. Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. Documents and logs information on tracking systems and mainframe systems. Generates appropriate written correspondence to providers, members, and regulatory entities. Participates in projects impacting development, interpretation, and implementation of medical policy or other managed care initiatives. Minimum Requirements Requires MS in social work, RN or degree in a related behavioral health field and minimum of 4 years of experience in a managed care/healthcare setting; or any combination of education and experience, which would provide an equivalent background. 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) or territory of the United States required. Preferred Skills, Capabilities, and Experiences Current active, unrestricted license as an LCSW, LMFT, Clinical Psychologist, LPC, or RN , issued in the State of California (CA) authorized to practice within scope of licensure strongly preferred. Professional Competencies For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills. Salary For candidates working in person or virtually in the below locations, the salary* range for this specific position is $84,000 to $126,000. Equal Employment Opportunity 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 may contact View email address on click.appcast.io for assistance. 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. #J-18808-Ljbffr Elevance Health