Manager, Grievance & Appeals

Centene Corp.; United States; Remote; USD 70.000 - 126.000; Vollzeit

Zusammenfassung

Centene seeks a Grievance & Appeals Coordinator for a remote role aligned to PST. The position handles processing of member grievances and appeals and coordinates with state agencies to ensure compliance with contractual timeframes.

The role requires a Bachelor's degree (or equivalent) and 3+ years in healthcare or law related to grievances. Leadership experience in cross-functional teams is preferred; Oregon RN licensure is strongly preferred.

Qualifikationen

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

Aufgaben

• Ensure processing of member grievances and appeals within timeframes.
• Monitor trends and provide monthly reporting to senior management.
• Work with state, local and federal entities related to grievance and appeals.
• Integrate federal and state law changes into regulatory system.
• May provide training to agencies on procedures.
• Review incoming incident/accident reports.

Kenntnisse

Cross-functional leadership

Staff supervision

Project management

Ausbildung

Bachelor's degree or equivalent experience

Jobbeschreibung

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

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.

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. 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