Manager, Grievance & Appeals

Centene Corporation•Remote-OR, OR

6d•$70,100 - $126,200•Remote

About The Position

Ensure appropriate processing of member grievance appeals, provider appeals, and requests for a State Fair Hearing. Serve as the point of contact with the State and manage the day-to-day responsibilities of the Grievance & Appeals Coordinators. This is a remote position with a schedule aligned to Pacific Standard Time (PST). Centene strongly prefers candidates residing in Oregon who hold an active Oregon RN license.

Requirements

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

Nice To Haves

Residence in Oregon.
Active RN licensure in Oregon.

Responsibilities

Ensure the Grievance and Appeals department processes appeals and grievances within required time frames and in compliance with contractual and legal requirements.
Monitor appeals and grievances and provide senior management with monthly trend reports.
Ensure member and provider grievances are processed and investigated according to contract requirements.
Work with external constituencies, including state, local, and federal governments, local communities, and the public, on grievance and appeals matters.
Integrate federal and state law changes into the company’s regulatory system related to grievance and appeals.
Recommend solutions and work with department and company staff to correct problems and advise departments on corrective measures to prevent recurrence.
Provide training and direction to agencies developing procedures to comply with grievance and appeals requirements, as needed.
Review and process incoming incident and accident reports.
Manage the day-to-day responsibilities of Grievance & Appeals Coordinators.