Get ready to interview in Richardson on May 15th, 16th, and 17th!
***There are multiple openings associated with this posting***
We are the Health Care Management division of HCSC — a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health care benefits.
We’re also tackling the social determinants of health by creating non-clinical partnerships in the communities where we work and live, because everyone should have access to quality health care. We use innovative tools and approaches to help members get the most out of their plan benefits, as affordably as possible. We are more than a health care insurer and we are truly anchored in our purpose: to do everything in our power to stand by our members in sickness and in health.
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.
Registered Nurse (RN) or Masters- level Behavioral Health Professional to practice at the independent practice level with current license in good standing in state of operations.
4 years clinical experience 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.
PREFERRED JOB REQUIREMENTS:
Masters- level Behavioral Health Professional. (LPC/LCSW)
Bilingual in English and Spanish.
Experience in processing appeals, denials or grievances in accordance with regulatory or accreditation requirements.
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.
Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma, Texas and several subsidiaries are part of the largest customer-owned health benefits company in the United States and fourth largest overall. We offer a full range of managed care programs for individuals, families, employer groups and Medicare beneficiaries. And we focus on improving the health and wellness of our members and communities by: offering a variety of health insurance and wellness products to employers and individuals; keeping our focus local; participating in our communities in meaningful ways such as Blue Corps employee volunteer program and our Healthy Kids, Healthy Families initiative. The commitment of our employees to providing superior services and products has made us one of the fastest growing health care insurance companies in the nation. 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, gender, national origin, disability, or protected veteran status.