Grievance & Appeals Manager (Remote Friendly)

Centene Corporation; Pennsylvania; Hybrid; USD 70,000 - 126,000; Full time

Job summary

Centene Corporation is seeking a clinical professional to join the Medical Management/Health Services team, focused on managing member grievance appeals and state-level interactions. This role emphasizes due process, timely processing, and collaboration with government entities.

The ideal candidate has a Bachelor’s degree and 3+ years in healthcare law, grievances, and appeals, with leadership experience managing cross-functional teams.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• 3+ years of healthcare/law, grievances and appeals experience.
• Experience leading cross-functional teams on large-scale projects or supervisory experience including hiring and training.

Responsibilities

• Ensure that all appeals and grievances are processed within referred time frames and other contractual requirements.
• Monitor appeals and grievances and provide monthly reporting on trends to senior management.
• Ensure that all member and provider grievances are processed and investigated according to contract requirements.
• Work with state, local and federal governments, local community and the public related to grievance and appeals.
• Integrate federal and state law changes into the regulatory system related to grievance and appeals.
• Recommend solutions and coordinate corrective measures across departments to prevent recurrences.
• May provide training to agencies in developing procedures to comply with grievance and appeals requirements.
• Review and process incoming incident/accident reports.

Skills

Leadership

Team supervision

Hiring

Training

Project management

Education

Bachelor's degree or equivalent

Job description

Centene Corporation is seeking a clinical professional to join the Medical Management/Health Services team, focused on managing member grievance appeals and state-level interactions. This role emphasizes due process, timely processing, and collaboration with government entities.

The ideal candidate has a Bachelor’s degree and 3+ years in healthcare law, grievances, and appeals, with leadership experience managing cross-functional teams.