Behavioral Health Appeals Coordinator Sr

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Anticipated End Date: 2026-06-25 Position Title: Behavioral Health Appeals Coordinator Sr Job Description: Behavioral Health Appeals Coordinator Senior 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. Please note that 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 from shift 8:00 am - 5:00 pm (PDT) Monday to Friday. Additional hours may be necessary based on company needs. The Elevance Health Companies, Inc. The Behavioral Health Appeals Coordinator Senior is responsible for investigating and processing the most complex grievances and appeals requests from members and providers related to behavioral health services. Serves as a technical resource to team and may be assigned to work on projects in support of medical policy and/or managed care initiatives. How you will make an impact. Primary duties may include, but are not limited to: 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. 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. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $84k to $126k Location(s): California US In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consiste

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