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 Purpose: Manages the correspondence and/or appeals, disputes, and reconsiderations process including the drafting and review of correspondence to ensure regulatory compliance. Manages issues and provides guidance on the review and timely processing to ensure compliance with internal policies and/or procedures according to and National Committee for Quality Assurance (NCQA) requirements.

• Maintains expert knowledge of contract requirements, policies, procedures, and performance standards.
• Ensures team’s compliance with contract requirements, policies, and procedures
• Reviews reporting and analyzes activities to identify trends and provides recommendations to team.
• Provides expert knowledge, guidance and education to team based on experience for any issues or/ questions escalated by external agencies, including state, local, and federal governments.
• Works with team and leadership to identify opportunities for process and quality improvement.
• Works with leadership team to provide updates and insights on goals and objectives.
• Assists with onboarding, hiring, and training Leads and champions change within scope of responsibility.
• Leads and manages others in a matrixed/cross functional environment with tight timeframes and strict deadlines.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: Requires a Bachelor's degree and 5+ years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. 2+ years supervisory experience preferred. Advanced knowledge of NCQA and state Medicaid program requirements preferred. Advanced knowledge of appeals process preferred. RN with compact license with BH background or LPC highly prefered.

Pay Range: $75,300.00 - $135,400.00 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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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