At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is  invested in your future!

Job Summary

**THIS IS A TELECOMMUTER ROLE**
**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**

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, determine appeals decisions or prepare cases for medical director review.

JOB REQUIREMENTS:
*Registered Nurse (RN) or Masters-level Behavioral Health Professional (LPC, LMFT, LCSW, LCPC, RPsy) with current license in good standing to practice at the independent practice level in state of operations.
*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.

 

#LI-Remote

Relocation assistance will not be provided for this position.

Sponsorship will not be provided for this position.

 

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:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.