Remote Grievance & Appeals Lead (RN) – Oregon

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

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Cross-functional leadership

Staff supervision

Project management

Education

Bachelor's degree or equivalent experience

Job description

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.