Director, Healthcare Appeals & Grievances

Centene Management Company LLC; Florida; Hybrid; USD 108,000 - 199,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Remote, hybrid, field or office work

Job summary

Centene Management Company LLC in Florida seeks a senior leader to oversee member appeals and grievance operations, ensuring efficient delivery, compliance, and continuous improvement. This role drives policies, training, and performance improvement across the department while coordinating with plan attorneys on litigated cases.

The position requires a Bachelor's degree (Master's preferred) and 5+ years in grievances or healthcare law, with prior management of cross-functional teams on large

Qualifications

• Bachelor's Degree in a related field or equivalent experience.
• Master's Degree preferred.
• 5+ years of experience in grievances, appeals, or healthcare law.

Responsibilities

• Oversees and directs the operations of appeals and grievances.
• Designs and implements processes, policies and procedures for compliance.
• Leads risk assessment activities and issue resolution.
• Manages cross-functional teams on large-scale projects.
• Coordinates with plan attorneys on litigated cases and case preparation.

Skills

Grievances management

Appeals processes

Healthcare law

Risk assessment

Regulatory compliance

Education

Bachelor's Degree in related field

Master's Degree preferred

Job description

Centene Management Company LLC in Florida seeks a senior leader to oversee member appeals and grievance operations, ensuring efficient delivery, compliance, and continuous improvement. This role drives policies, training, and performance improvement across the department while coordinating with plan attorneys on litigated cases.

The position requires a Bachelor's degree (Master's preferred) and 5+ years in grievances or healthcare law, with prior management of cross-functional teams on large