Lead Grievance & Appeals Coordinator

Centene Management Company LLC; Illinois; Hybrid; USD 32,000 - 55,000; Full time

Benefits offered by this job

Remote work from home

Flexible schedule

Job summary

Centene Management Company LLC is seeking a healthcare professional to lead our Illinois Medicaid and YouthCare grievance & appeals processing team, with remote work options.

This role supports daily operations, coaching staff, ensuring NCQA standards, and preparing monthly reports, with a 8am-5pm Central schedule and on-call weekends.

Qualifications

• Bachelor's degree in related field or equivalent experience.
• 2+ years of grievance and appeals experience in a healthcare or managed care setting.

Responsibilities

• Maintain a smaller caseload and provide updates on daily completion by assigned team members.
• Error management and coaching staff to improve processes.
• Support state fair hearing process as needed and run daily huddles.

Skills

Grievance & appeals

Healthcare operations

Education

Bachelor's degree

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

THIS POSITION IS REMOTE/WORK FROM HOME SUPPORTING OUR ILLINOIS HEALTH PLAN MEDICAID AND YOUTHCARE GRIEVANCE & APPEALS PROCESSING TEAM. THE WORK SCHEDULE IS MONDAY - FRIDAY 8AM - 5PM CENTRAL TIME ZONE WITH OVER-TIME AS NEEDED DURING THE WEEK AND APPROXIMATELY EVERYOTHER WEEKEND FOR SOME ON-CALL DUTIES.

Lead Responsibilities

• MAINTAIN A SMALLER CASELOAD PROVIDE UPDATES ON STATUS' OF: DAILY CASE COMPLETION BY ASSIGNED TEAM MEMBERS
• ERROR MANAGEMENT
• RUN DAILY HUDDLES
• CONTRIBUTE TO JOB AIDS
• Q&A
• SUPPORT PROCESS CHANGES
• COACHING STAFF
• AND SUPPORT STATE FAIR HEARING PROCESS AS NEEDED
• AMONG OTHER DUTIES

Position Purpose

Provide support and direction for the daily operations of the appeals function Provide consultation for problem resolution for appeals staff and monitor team work output to ensure compliance with internal and NCQA standards Identify training, process improvement and resource needs to maximize team performance and recommend action plans to management Review denial and appeal letters as needed to ensure appropriate content and message Prepare for state/health plan audits, response to complaints and request for state fair hearing documentation Prepare monthly reports, logs, and other health plan or state contractual requirements Review and monitor team workload and output to ensure optimum efficiency and accuracy Serve as the point of contact for issues that arise from members, providers and internal team Train and educate new and existing team on processes, policies and procedures, and contract or market requirements Performs other duties as assigned Complies with all policies and standards

Education/Experience

• Bachelor's degree in related field or equivalent experience.
• 2+ years of grievance and appeals experience in a Healthcare or Managed Care setting.

Pay Range

Pay Range: $23.23 - $39.61 per hour

Benefits

• Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

EEO Statement

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.