Manager, Grievance & Appeals

Centene Corporation•Remote-PA, PA

1d•$70,100 - $126,200•Remote

About The Position

Centene is seeking a Manager, Grievance & Appeals to join their Medical Management/Health Services team. This role is crucial for ensuring the appropriate processing of member grievance appeals, provider appeals, and requests for State Fair Hearings. The manager will serve as the point of contact with the State and oversee the daily operations of the Grievance & Appeals Coordinators. This position offers a competitive benefits package and a flexible approach to workplace arrangements, including remote, hybrid, field, or office options.

Requirements

Bachelor’s degree in related field or equivalent experience.
3+ plus years of experience in healthcare/law, grievances and appeals.
Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

Responsibilities

Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State Fair Hearing.
Perform duties as the point of contact with the State.
Manage the day to day responsibilities of the Grievance & Appeals Coordinators.
Ensure that the Grievance and Appeals department processes all appeals and grievances in accordance with referred time frames and other contractual legal requirements.
Monitor appeals and grievances and provide senior management with monthly reporting on trends.
Ensure that all members and provider grievances are processed and investigated according to contract requirements.
Work with various external constituencies, i.e., state, local and federal governments, local community and the public related to grievance and appeals.
Integrate federal and state law changes into company’s regulatory system related to grievance and appeals.
Recommend solutions and works with department and company staff to ensure problems are corrected and departments are advised of corrective measures to prevent recurrences.
May provide training and direction to agencies in developing procedures to comply with grievance and appeals requirements.
Review and process incoming incident/accident reports.