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6d ago Curated

Supervisor, Appeals

Centene
  • Utilization Review
  • Full-time
  • $75,000 – $110,000
  • License: Compact
  • 3+ years

Job description

Supervise a team of appeals nurses reviewing member grievances and appeals related to medical necessity determinations. Ensure compliance with regulatory timelines and quality standards. Conduct audits, provide coaching, and collaborate with medical directors. Requires active RN license and 3+ years of managed care or appeals experience.

Key responsibilities

  • Supervise appeals team
  • Review and process member appeals
  • Ensure regulatory compliance
  • Conduct quality audits
  • Provide coaching and training

What you bring

  • Active RN license
  • 3+ years managed care/appeals experience
  • Knowledge of NCQA and CMS regulations
  • Leadership skills

Tags

RemoteAppealsSupervisorManaged Care

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