Behavioral Health Clinical Appeals Reviewer

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for coordinating clinical appeals/grievances and complaints for Behavioral Health, reporting, monitoring, scheduling and facilitating appeals according to various regulatory requirements. Analyzes appeals data, determines appeals decisions or prepare cases for Medical Director review.

Job Requirements:
*Registered Nurse (RN) or Masters-level Behavioral Health Professional (LPC, LMFT, LCSW, LCPC) with current license to practice at the independent practice level.
*4 years clinical experience (post licensure at the independent practice level) to include implementing or administering managed care or quality assurance activities.
*Knowledge and understanding of state and federal guidelines and regulations.
*Written and verbal communication skills and facilitating skills.
*Interpersonal skills to interface with internal and external customers, including representative of Department of Insurance and government agencies in a rapport-developing manner.
*Organizational skills.
*Detail oriented.


Preferred Job Requirements:
*Bilingual in English and Spanish.
*Experience in processing appeals, denials or grievances in accordance with regulatory or accreditation requirements.
*Experience in Utilization Management or audit.

** Masters-level Behavioral Health Professionals: Please note that you MUST be licensed to practice at the independent level for this role. The # of years of clinical experience required for this role is post licensure (# of years) at the independent level**

*Strong Utilization Review (UR) experience, needed.

*Knowledge of Excel (Microsoft Suite) is needed, as well Experience with Claims, Data Analytics, Electronic Records, is preferred*

#LI-Remote

This is a Telecommute (Remote) role for TX, OK, NM, MT and IL: Must reside anywhere within the posted State(s).
Work Schedule: Work Hours are Monday through Friday 8:30 AM to 5:30 PM (Time Zone aligned)

Sponsorship is not available.

The Compensation/Salary offered for this Position will vary depending on Job-related skills, education, knowledge and experience. This role aligns with an Annual Performance Incentive (Bonus) plan.

We encourage people of all backgrounds and experiences to apply.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$58,800.00 - $130,100.00 Apply