Remote Grievance & Appeals Manager (RN, OR)

Centene Corp.; 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

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.