Grievance & Appeals Lead Manager - Remote (PST)

Centene Corporation; Salem (OR); Remoto; USD 70.000 - 126.000; Tempo pieno

Descrizione del lavoro

Centene Corporation is seeking a Grievance & Appeals Manager to ensure timely processing of member and provider appeals and state fair hearing requests. The role is remote with PST hours and a strong preference for an Oregon-resident candidate with an active Oregon RN license.

You will monitor trends, report to senior management, and lead cross-functional teams while ensuring compliance with contracts and regulations. Experience in healthcare law and supervisory roles is required.

Competenze

• Bachelor’s degree in related field or equivalent experience.
• 3+ years in healthcare, law, grievances and appeals.

Mansioni

• Process all appeals/grievances within contractual timeframes and legal requirements.
• Monitor appeals/grievances and provide monthly reporting on trends.
• Ensure member/provider grievances are processed and investigated per contract.
• Collaborate with state/local/federal agencies and the public on grievances.
• Integrate federal/state law changes into the regulatory system for grievances.
• Recommend corrective actions and prevent recurrences with staff.
• May train agencies to develop compliant grievance/appeals procedures.
• Review and process incoming incident/accident reports.

Conoscenze

Oregon RN licensure

Leadership

Cross-functional teams

Training staff

Formazione

Bachelor's degree

Descrizione del lavoro

Centene Corporation is seeking a Grievance & Appeals Manager to ensure timely processing of member and provider appeals and state fair hearing requests. The role is remote with PST hours and a strong preference for an Oregon-resident candidate with an active Oregon RN license.

You will monitor trends, report to senior management, and lead cross-functional teams while ensuring compliance with contracts and regulations. Experience in healthcare law and supervisory roles is required.