Supervisor, Denials (RN)

Cenetene Corporation; Austin (TX); Remote; USD 62,000 - 113,000; Full time

Job summary

A leading healthcare organization seeks a clinical professional to supervise correspondence processing within their Medical Management team. This role involves ensuring compliance with NCQA standards, providing team guidance, and identifying process improvements. The position offers flexibility to work remotely from anywhere in the U.S., along with a competitive salary and comprehensive benefits package.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Qualifications

• 4+ years of related experience required.
• Knowledge of NCQA and denials process preferred.
• Compact RN license required.

Responsibilities

• Supervise correspondence processing and ensure compliance with NCQA.
• Provide guidance and coaching to the correspondence team.
• Monitor performance and identify process improvements.

Skills

Leadership

Compliance Knowledge

Process Improvement

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.**

+ Monitors and tracks all correspondence issues and researches to ensure documentation, processing, and resolution is in accordance with established policies and procedures

+ Provides expert knowledge and guidance based on experience to the correspondence team for issue resolution and processing to ensure compliance with state and National Committee for Quality Assurance (NCQA) requirements

+ Maintains knowledge of contract requirements, policies, procedures, and ensures correspondence team’s compliance with contract requirements, policies, procedures, and performance standards

+ Works with team to identify opportunities for process and quality improvements within the denial processing and review process

+ Evaluates team performance and provides feedback regarding performance, goals, and career milestones

+ Provides coaching and guidance to team to ensure timely documentation for services and improve processing and quality of correspondence

+ Assists with onboarding, hiring, and training of team members

+ Leads and champions change within scope of responsibility

+ Performs other duties as assigned

+ Complies with all policies and standards

**Education/Experience:** Requires a Bachelor's degree and 4+ years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Knowledge of NCQA, federal, and state requirements preferred. Knowledge of denials process preferred. Compact RN license 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 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. Total compensation may also include additional forms of incentives.

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