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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 IS REMOTE***
**THIS TEAM PROCESSES APPEALS ONLY**
**Appeals Experience HIGHLY Preferred**
Position Purpose: The Supervisor of Appeals & Grievances is accountable for the recruitment, hiring, promotion, counseling, and daily supervision of Grievance and Appeals Specialists and administrative support as they receive, investigate and resolve member complaints, member grievances, and provider disputes. This position is also responsible for the coordination of the resolution of grievance situations requiring competent and effective resolution in compliance with legal and regulatory requirements. This position will also perform initial and ongoing training in necessary skills and knowledge base and will assist Manager of Grievance and Appeals to establish and maintain procedures for Unit to maximize both outcomes and operational efficiency.
- Provides daily supervision for Grievance and Appeals Unit, including coordination of backup staffing, cross-training and deployment.
- Performs recruiting, hiring, promotion, and performance evaluation tasks and counsels non-clinical Grievance and Appeals staff.
- Orients and trains new Grievance and Appeals Unit members.
- Continually trains Unit members concerning grievances, appeals, and provider disputes/appeals.
- Regularly audits work of G&A Specialists and reports results.
- Coordinates investigation and resolution of complex appeal and grievance issues.
- Provides approval decisions involving grievance and appeal determinations.
- Coordinates maintenance and updates of desktop procedures and manuals for Unit.
- Assists in the establishment of grievance operating procedures.
- Prepares reports as required and performs trend analyses.
- Participates in Health Plan audits as needed.
- Performs other related duties as required.
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: High School Diploma. Bachelor’s Degree preferred. 5+ years of experience in Managed Care. 2+ supervisory experience preferred.
Pay Range: $55,100.00 - $99,000.00 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
