Manager, Grievance & Appeals

Centene Corp.; Arizona; Remote; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health Insurance

401K

Stock Purchase Plan

Tuition Reimbursement

Paid Time Off

Holidays

Flexible Schedule

Job summary

Centene Corp. seeks a Manager of Grievance & Appeals to ensure accurate and timely processing of member grievances and provider appeals.

This role coordinates with state agencies and internal teams to ensure compliance with contractual and legal requirements, and it guides process improvements across the department. The ideal candidate will bring 3+ years of healthcare regulatory experience, strong leadership, and proven ability to manage cross-functional projects.

Qualifications

• Bachelor's degree or equivalent experience required.
• 3+ years in healthcare, law, grievances and appeals.
• Experience as a lead or supervisor managing cross-functional teams.

Responsibilities

• Ensure timely processing of member grievances and provider appeals according to contract timeframes.
• Monitor appeals/grievances and provide monthly trend reports to senior management.
• Ensure all grievances/appeals are investigated and processed per contract requirements.
• Collaborate with state, local and federal entities and other external stakeholders.
• Incorporate federal/state law changes into the regulatory system for grievances and appeals.
• Provide guidance and training to agencies on procedures to comply with requirements.
• Review and process incoming incident/accident reports.

Skills

Healthcare regulatory knowledge

Leadership

Project management

Regulatory compliance

Education

Bachelor's degree or equivalent experience

Job description

Manager, Grievance & Appeals page is loaded## Manager, Grievance & Appealslocations: Remote-AZtime type: Full timeposted on: Posted Todayjob requisition id: 1672955**Position Purpose:** Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State Fair Hearing. Perform duties as the point of contact with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators.**Key Details:** Candidate must live in Arizona.* Ensure that the Grievance and Appeals department processes all appeals and grievances in accordance with referred time frames and other contractual legal requirements* Monitor appeals and grievances and provide senior management with monthly reporting on trends* Ensure that all members and provider grievances are processed and investigated according to contract requirements* Work with various external constituencies, i.e., state, local and federal governments, local community and the public related to grievance and appeals* Integrate federal and state law changes into company's regulatory system related to grievance and appeals* Recommend solutions and works with department and company staff to ensure problems are corrected and departments are advised of corrective measures to prevent recurrences* May provide training and direction to agencies in developing procedures to comply with grievance and appeals requirements* Review and process incoming incident/accident reports**Education/Experience:** Bachelor's degree in related field or equivalent experience. 3+ plus years of experience in healthcare/law, grievances and appeals. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.Pay Range: $70,100.00 - $126,200.00 per year**At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day.** You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.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. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.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 Actlocations: 2 Locationstime type: Full timeposted on: Posted 5 Days AgoThanks for your interest in Centene and its subsidiary companies. We're so glad that you've decided to fill out an application and take the next step to find your purpose. Also, we're here to help support you on your candidate journey. Should you need an accommodation, please email