Supervisor, Denials (RN)

Centene Corporation; Alaska; Hybrid; USD 62,000 - 113,000; Full time

Job summary

A leading healthcare organization seeks a clinical professional for their Medical Management team. This role involves supervising correspondence processes and ensuring compliance with NCQA standards. With a focus on team performance and quality improvements, the position offers flexibility to work remotely from anywhere in the U.S.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• Requires a Bachelor's degree and 4+ years of related experience.
• Knowledge of NCQA, federal, and state requirements is preferred.

Responsibilities

• Monitors and tracks all correspondence issues.
• Provides expert knowledge and guidance for issue resolution.
• Evaluates team performance and provides feedback.

Skills

Compliance

Leadership

Problem Solving

Education

Bachelor's degree

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose:

Supervises drafting and processing of correspondence in accordance with National Committee for Quality Assurance (NCQA) requirements. Supervises day-to-day activities and provides guidance to the team to ensure correspondence is reviewed and processed timely.

Applicants for this job have the flexibility to work remote from home anywhere in the United States.

Responsibilities:

1. Monitors and tracks all correspondence issues and researches to ensure documentation, processing, and resolution is in accordance with established policies and procedures.
2. Provides expert knowledge and guidance based on experience to the correspondence team for issue resolution and processing to ensure compliance with state and NCQA requirements.
3. Maintains knowledge of contract requirements, policies, procedures, and ensures team’s compliance with these standards.
4. Works with the team to identify opportunities for process and quality improvements within denial processing and review.
5. Evaluates team performance and provides feedback regarding goals and career development.
6. Provides coaching and guidance to ensure timely documentation and improve processing quality.
7. Assists with onboarding, hiring, and training of team members.
8. Leads and champions change within scope of responsibility.
9. Performs other duties as assigned.
10. Ensures compliance with all policies and standards.

Education and Experience:

Requires a Bachelor's degree and 4+ years of related experience, or equivalent experience demonstrating relevant knowledge and skills. Knowledge of NCQA, federal, and state requirements is preferred. Knowledge of the denials process is also preferred. A compact RN license is required.

Pay Range: $62,400.00 - $112,400.00 per year

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements (remote, hybrid, field, or office schedules). Actual pay will be adjusted based on skills, experience, education, and other factors. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.