Manager, Grievance & Appeals

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene Corp. is seeking a Grievance & Appeals Coordinator to manage processing of member grievances and appeals.

The role serves as the point of contact with the State and will align with PST for a remote work arrangement, with a preference for an Oregon resident holding an active Oregon RN license. The position involves leading a team, coordinating with state and local agencies, and ensuring timely, compliant investigations and reporting.

Qualifications

• Bachelor's degree in related field or equivalent experience.
• 3+ years of healthcare/law, grievances and appeals.
• Lead or supervisory experience including hiring, training, and managing staff.

Responsibilities

• Ensure all appeals and grievances are processed within required timeframes and contractual requirements
• Monitor appeals trends and provide monthly reports to senior management
• Process member and provider grievances per contract requirements
• Collaborate with state, local, federal governments, communities, and public on grievance matters
• Incorporate federal and state law changes into the regulatory system for grievance and appeals
• Provide guidance to agencies on procedures to comply with grievance and appeals
• Review and process incoming incident/accident reports

Skills

Grievance & Appeals

Leadership

Cross-functional teamwork

Regulatory compliance

Education

Bachelor's degree

Job description

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: This is a remote position and the schedule will align with Pacific Standard Time (PST). Strongly prefer a candidate residing in Oregon who holds an active RN licensure in the state of Oregon.

• 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
• 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 Act