Manager, Grievance & Appeals

Centene Management Company LLC; Oregon; Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health insurance

401K plan

Stock purchase

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Management Company LLC is seeking a Grievance & Appeals Coordinator for a remote role aligned to Pacific Standard Time. Preference for an Oregon resident with an active RN license.

You will ensure timely processing of member grievances and appeals, coordinate with state/federal entities, and report monthly trends to senior leadership. Responsibilities include applying regulatory changes to the system, training agencies, reviewing incident reports, and driving corrective actions with

Qualifications

• Bachelor's degree or equivalent experience.
• 3+ years in healthcare/law, grievances and appeals.
• Experience as a lead managing cross-functional teams on large projects or supervisory experience including hiring, training, and performance management.

Responsibilities

• Process member grievances and appeals in accordance with contractual timeframes and regulations.
• Act as primary contact with state agencies and coordinate with local, state, and federal entities.
• Provide monthly reporting on trends to senior management and implement corrective actions.

Skills

Attention to detail

Communication

Leadership

Education

Bachelor's degree or equivalent experience

RN licensure in Oregon

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

Benefits

• 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.

Equal Opportunity

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.

About Centene

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 is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.