Supervisor, Denials (RN)

Centene; United States; Remote; USD 62,000 - 113,000; Full time

Job summary

Join a leading healthcare organization as a clinical professional in Medical Management. You will supervise correspondence processing, ensure compliance with NCQA standards, and lead a dedicated team. Enjoy flexible work arrangements and a comprehensive benefits package.

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 preferred.

Responsibilities

• Supervises drafting and processing of correspondence.
• Monitors and tracks all correspondence issues.
• Provides coaching and guidance to the team.

Skills

Leadership

Compliance

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.

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 the team’s compliance with these standards.
4. Works with the team to identify opportunities for process and quality improvements within the denial processing and review process.
5. Evaluates team performance and provides feedback regarding performance, goals, and career milestones.
6. Provides coaching and guidance to the team to ensure timely documentation for services and improve processing and quality of correspondence.
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/Experience:

Requires a Bachelor's degree and 4+ years of related experience or equivalent experience reflecting the duties, scope, and skills of this position. 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 individual 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 applicable laws.

About the company

Centene Corporation is a publicly traded managed care company based in St. Louis, Missouri.