Manager, Grievance & Appeals

Company: California Health & Wellness
Location: Woodland Hills
Posted on: January 27, 2023

Job Description:

You could be the one who changes everything for our 26 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 Purpose: Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State Fair Hearing. Perform duties as the point of contact with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators.

--- Ensure that the Grievance and Appeals department processes all appeals and grievances in accordance with referred time frames and other contractual legal requirements
--- Monitor appeals and grievances and provide senior management with monthly reporting on trends
--- Ensure that all members and provider grievances are processed and investigated according to contract requirements
--- Work with various external constituencies, i.e., state, local and federal governments, local community and the public related to grievance and appeals
--- Integrate federal and state law changes into company's regulatory system related to grievance and appeals
--- Recommend solutions and works with department and company staff to ensure problems are corrected and departments are advised of corrective measures to prevent recurrences
--- May provide training and direction to agencies in developing procedures to comply with grievance and appeals requirements
--- Review and process incoming incident/accident reports

Education/Experience: Bachelor's degree in related field or equivalent experience. 3+ plus 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 including hiring, training, assigning work and managing the performance of staff.

Pay range: $74,200 0 to $133,400 per year

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. The employee may be eligible for bonuses and other forms of compensation.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.

Keywords: California Health & Wellness, Los Angeles , Manager, Grievance & Appeals, Executive , Woodland Hills, California