Senior Manager, Payment Integrity & Readmission Audits

Visa Hunt; United States; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Job summary

Centene is seeking a leader to manage auditors and clinical professionals focused on potentially preventable readmissions and payment integrity. You will oversee readmission review programs ensuring accurate determinations and alignment with policies and regulatory requirements.

The role requires an RN with coding credentials, experience with DRG/MS-DRG, and strong leadership. Remote, hybrid, field, or office work arrangements are available with competitive pay and benefits.

Qualifications

• Bachelor’s degree required; 4+ years in related experience may substitute.
• 5+ years in Payment Integrity including readmission review and DRG validation.
• 3+ years people leadership experience.

Responsibilities

• Lead and oversee Payment Integrity initiatives focused on readmissions and payment accuracy.
• Monitor program performance against defined metrics and financial targets.
• Prepare and present reports to leadership and stakeholders.
• Provide coaching and develop team members to promote quality and collaboration.
• Act as SME for Payment Integrity practices and reimbursement considerations.

Skills

RN background

Coding background

Leadership

Education

Bachelor's in Healthcare Administration/Business/Public Health/Health Information Management/Nursing

Master’s degree preferred

Tools

3M encoder

Optum Encoder

TruCode

TRU-BRIDGE

Job description

Centene is seeking a leader to manage auditors and clinical professionals focused on potentially preventable readmissions and payment integrity. You will oversee readmission review programs ensuring accurate determinations and alignment with policies and regulatory requirements.

The role requires an RN with coding credentials, experience with DRG/MS-DRG, and strong leadership. Remote, hybrid, field, or office work arrangements are available with competitive pay and benefits.