Manager, Grievance & Appeals

Centene Corporation

. Ensure appropriate processing of member grievance appeals, provider appeals, or requests for a State Fair Hearing .

Posted 10/30/2026full-timeRemote • Oregon • United StatesMid-LevelSenior💰 $70,100 - $126,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing grievance and appeals processes within healthcare, ensuring compliance with state and federal regulations. Proven ability to lead cross-functional teams, provide training, and deliver trend reporting to senior management.

Highest-signal resume keywords

Grievance And Appeals ManagementRegulatory ComplianceSupervisory ExperienceHealthcare ExperienceRN Licensure In Oregon

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Grievance ProcessingAppeals ProcessingIncident Report ReviewTrend ReportingContractual Legal Requirements

Soft Skills

LeadershipTrainingProblem SolvingCommunication

Certifications & Qualifications

Active RN Licensure In Oregon

Industry Keywords

HealthcareState Fair HearingFederal Law ComplianceCross Functional TeamsPerformance Management

About the role

Key responsibilities & impact

Ensure appropriate processing of member grievance appeals, provider appeals, or requests for a State Fair Hearing
Serve as the point of contact with the State
Manage the day-to-day responsibilities of Grievance & Appeals Coordinators
Ensure appeals and grievances are processed within required time frames and contractual legal requirements
Monitor appeals and grievances and provide senior management with monthly trend reporting
Ensure member and provider grievances are processed and investigated according to contract requirements
Work with 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
Recommend solutions and work with department and company staff to correct problems and prevent recurrences
Provide training and direction to agencies developing compliant procedures
Review and process incoming incident/accident reports

Requirements

What you’ll need

Bachelor’s degree in related field or equivalent experience
3+ 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
Supervisory experience including hiring, training, assigning work and managing the performance of staff
Strongly preferred: residing in Oregon
Strongly preferred: active RN licensure in the state of Oregon
Schedule aligned with Pacific Standard Time (PST)

Benefits

Comp & perks

competitive pay
health insurance
401K and stock purchase plans
tuition reimbursement
paid time off plus holidays
a flexible approach to work with remote, hybrid, field or office work schedules
additional forms of incentives may be included in total compensation
Equal opportunity employer committed to diversity