Remote Grievances & Appeals Manager (RN, Oregon)

Trillium Community Health Plan; United States; Remote; USD 70,000 - 126,000; Full time

Job summary

Centene is seeking a Grievance & Appeals Coordinator to ensure timely processing of member grievances and provider appeals, serving as the primary point of contact with state authorities. The role manages day-to-day responsibilities of the Grievance & Appeals Coordinators, with a remote work arrangement aligning to PST and a strong preference for an Oregon RN license holder.

The candidate will supervise staff, monitor trends, and coordinate with state and federal bodies to implement regulatory

Qualifications

• 3+ years of experience in healthcare, law, grievances and appeals.
• Previous experience as a lead supervising staff and cross-functional teams.
• Bachelor’s degree in a related field or equivalent experience.

Responsibilities

• Process member grievances and provider appeals in accordance with contract requirements and timelines.
• Monitor and report monthly trends to senior management.
• Coordinate with state, local and federal entities related to grievance and appeals.
• Incorporate federal/state regulatory changes into the company’s grievance and appeals process.
• Provide training and guidance to agencies on procedures for compliance.
• Review and process incoming incident/accident reports.

Skills

Grievances & Appeals

Leadership

Healthcare law

Cross-functional teamwork

Education

Bachelor’s degree or equivalent

Job description

Centene is seeking a Grievance & Appeals Coordinator to ensure timely processing of member grievances and provider appeals, serving as the primary point of contact with state authorities. The role manages day-to-day responsibilities of the Grievance & Appeals Coordinators, with a remote work arrangement aligning to PST and a strong preference for an Oregon RN license holder.

The candidate will supervise staff, monitor trends, and coordinate with state and federal bodies to implement regulatory