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.

THIS ROLE IS REMOTE/WORK FROM HOME WITH 10% TRAVEL TO AN OFFICE HUB FOR MANDATORY MEETINGS. IT IS PREFERRED THAT APPLICANTS RESIDE IN THE STATE OF PENNSYLVANIA.

THE ROLE WILL SUPPORT PENNSYLVANIA HEALTH & WELLNESS GRIEVANCE AND APPEALS MEDICAID TEAM.

CORE BUSINESS HOURS WILL BE MONDAY-FRIDAY, 8AM - 5PM, HOWEVER NEEDS TO BE FLEXIBLE TO MEET THE BUSINESS NEEDS.

Position Purpose: Supervise the day to day operations of the Appeals and Grievance (A&G) staff and functions within the department ensuring productivity and quality metrics are met. Support the team on escalated or complex issues and monitor and distribute case load.

• Ensure that the Appeals & Grievance department processes all Medicare appeals, grievances and complaints in accordance with CMS standards and the corporation’s policies and procedures

• Serve as a resource to the team regarding escalated or complex issues, process and systems issues, and regulatory updates

• Monitor and distribute team’s case load and ensure adequate coverage

• Monitor and evaluate performance standards and provide daily feedback and guidance of problem resolution

• Identify and develop opportunities for process improvements and work with various departments to ensure problems are corrected to prevent recurrences

• Train and onboard new team members

Education/Experience: Bachelor’s degree in a related field or equivalent experience. 2+ years of appeals and grievances processing experience in a healthcare or managed care setting preferred. Experience in healthcare law preferred.Pay Range: $54,000.00 - $97,100.00 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