Manager, Grievance & Appeals

Centene Corporation•Remote-AZ, AZ

2d•$70,100 - $126,200

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. The candidate must live in Arizona.

Requirements

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

Responsibilities

Ensure the Grievance and Appeals department processes appeals and grievances within the applicable time frames and in accordance 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, the local community, and the public, on grievance and appeals matters.
Integrate federal and state law changes related to grievance and appeals into the company's regulatory system.
Recommend solutions and work with department and company staff to correct problems and advise departments on corrective measures to prevent recurrence.
May provide training and direction to agencies developing procedures to comply with grievance and appeals requirements.
Review and process incoming incident and accident reports.
Manage the day-to-day responsibilities of the Grievance & Appeals Coordinators.