Top 773 Quality improvement rn Jobs in Louisiana

RN Readmission Manager, Payment Integrity
Centene Corporation —Louisiana
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
7d
Chief Flight Nurse
Acadian Air Med —Lafayette, LA
- Urgently hiring
- Nursing
- RN License
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
7d
RN ER
TalentBurst, Inc. —New Orleans, LA
- $2,187.00 - $2,194.20 a week
- Contract
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Nurse Home Visitor
Southeast Louisiana AHEC —Tangipahoa, LA
- $57,408 - $78,874 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Health insurance
- Dental insurance
Quick Apply
RN - Labor and Delivery
TalentBurst, Inc. —Baton Rouge, LA
- $1,966 - $2,038 a week
- 12 hour shift
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
12d
Registered Nurse Surgical Services
Rapides Regional Medical Center —Alexandria, LA
- Full-time
- Surgery
- Mid-level
- Perioperative Care
- Employee stock purchase plan
- Disability insurance
Quick Apply
1d
Nurse Home Visitor
Southeast Louisiana AHEC —Houma, LA
- $57,408 - $78,874 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Health insurance
- Dental insurance
Quick Apply
5d
CLINICAL REVIEW SPECIALIST-RN-PATIENT SAFETY/RISK MANAGEMENT
North Oaks Health System —Hammond, LA
- Full-time
- Microsoft Word
- Nursing
- RN License
Registered Nurse (RN)
Business Health Partners —Westlake, LA
- From $30 an hour
- Full-time
- Nursing
- Medication administration
- RN License
- Health insurance
- Dental insurance
Quick Apply
RN - NICU
TalentBurst, Inc. —Lafayette, LA
- $1,858 - $1,930 a week
- 12 hour shift
- Nursing
- RN License
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
1d
Registered Nurse (RN) - ICU - Ochsner West Bank - Nights
Ochsner Health System —Gretna, LA
- Full-time
- Nursing
- RN License
- BLS Certification
Registered Nurse (RN) - Nights
Oceans Healthcare —Alexandria, LA
- Rotating shift
- Nursing
- Management
- Psychiatry
- Disability insurance
- Health insurance
Quick Apply
MDS Coordinator -LPN/RN
HILLTOP NURSING & REHABILITATION CENTER —Pineville, LA
- From $26 an hour
- Full-time
- Anatomy knowledge
- RN License
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
5d
RN Medical ICU - Jeff Hwy - Full Time - Shift of Greatest Need
Ochsner Health System —New Orleans, LA
- Full-time
- Nursing
- RN License
- BLS Certification
Registered Nurse - ICU - Nights
Ochsner Health System —Gretna, LA
- Full-time
- Nursing
- RN License
- BLS Certification
RN - ICU - Night Shift - Kenner - Full Time
Ochsner Health System —Kenner, LA
- Full-time
- Nursing
- RN License
- BLS Certification
Registered Nurse - ICU - PRN - Day Shift - St. Bernard Parish Hospital
Ochsner Health System —Chalmette, LA
- PRN
- Nursing
- RN License
- BLS Certification
Nurse Home Visitor
Southeast Louisiana AHEC —Alexandria, LA
- $57,408 - $78,874 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse - ICU - PRN - Days - St. Bernard Parish Hospital
Ochsner Health System —Chalmette, LA
- PRN
- Nursing
- RN License
- BLS Certification
RN - Medical/Surgical Tele
TalentBurst, Inc. —Baton Rouge, LA
- $1,858 - $1,930 a week
- 12 hour shift
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
1d

I want to receive the latest job alert for quality improvement rn in louisiana

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

quality improvement rn jobs near louisiana

Registered Nurse Icu jobs in New Orleans, LA

Registered Nurse Nicu jobs in Lafayette, LA

Chief Nursing Officer jobs in Lafayette, LA

Registered Nurse jobs in Alexandria, LA

Registered Nurse Emergency Room jobs in New Orleans, LA

Registered Nurse Manager jobs in Lafayette Hill, PA

Registered Nurse Manager jobs in Bothell, WA

District Manager jobs in Detroit, MI

Accounting Manager jobs in Denver, CO

Healthcare Project Manager jobs in Virginia

Registered Nurse jobs in San Antonio, TX

Registered Nurse Manager jobs in New York, NY

Registered Nurse Manager jobs in Corvallis, OR

Ahn Registered Nurse jobs in Pittsburgh, PA

Registered Dietitian jobs in Colorado

Registered Behavior Technician jobs in Wilmington, NC

Per Diem Icu jobs in New York, NY

Outpatient Nurse jobs in Savannah, GA

Nurse Auditor jobs in Denver, CO

Entry Level New Grad Nurse jobs in Modesto, CA

RN Readmission Manager, Payment Integrity

Centene Corporation -
Louisiana

Apply Now

Job Details

Full-time
$87,700 - $157,800 a year
7 days ago

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Medical claims processing software
Healthcare team management
Healthcare reimbursement methods
Healthcare coding investigations
Documentation reviews
DRG

Full Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

A Licensed RN paired with a Coding Credential is the candidate this team is seeking for this position that will lead and oversee PI initiatives focused on potentially preventable readmissions, cost recovery, cost avoidance, and payment accuracy. You will lead a team focused on expanded readmission reviews allowing CNC to ensure payment accuracy as well as alignment with internal policies and regulatory requirements. Experience Required for all RN's with Coding Credentials applying:

5 + years of progressive experience in Payment Integrity, including readmission review and DRG validation activities, required.
3+ years of people leadership experience, including direct management of teams, required.
2+ or more years of experience using Diagnosis Related Group encoder and grouper tools (for example, 3M, Optum Encoder, TruCode, TruBridge, WebSTRAT, Payment Systems Incorporated, or similar tools), required.

Position Purpose:
Manages a team of auditors and clinical professionals and is accountable for audit quality, consistency, and overall program performance for potentially preventable readmissions. Oversees payer readmission review programs to ensure accurate, compliant determinations and achievement of payment integrity objectives. This role directs the identification and validation of potentially preventable readmissions while supporting appropriate reimbursement under MS-DRG and APR-DRG methodologies. Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices.

Lead and oversee Payment Integrity initiatives focused on potentially preventable readmissions, cost recovery, cost avoidance, and payment accuracy, ensuring alignment with established objectives, internal policies, and regulatory requirements.
Collaborate with Health Plans, Medical Economics, Finance, Compliance, Legal, Provider Relations, and Technology teams to support the design, execution, and ongoing monitoring of readmission and DRG-related Payment Integrity strategies.
Monitor program performance against defined metrics, financial targets, and operational benchmarks, using trend analysis to identify risks, variances, and opportunities for improvement.
Provide leadership and operational oversight to teams performing readmission, MS-DRG, and APR-DRG reviews, ensuring accuracy, consistency, timeliness, and adherence to established review standards.
Ensure compliance with federal and state regulations, managed care organization requirements, contractual obligations, and internal policies governing Payment Integrity and audit activities.
Prepare and present reports, analyses, and performance summaries to leadership and key stakeholders, highlighting audit outcomes, trends, and actionable recommendations.
Identify process gaps, operational risks, and control weaknesses, and implement or recommend corrective actions to improve quality, efficiency, and program effectiveness.
Lead, coach, and develop team members by setting clear expectations, promoting accountability, and fostering a culture of collaboration, quality, and continuous improvement.
Serve as a subject matter expert for Payment Integrity practices within assigned scope, providing guidance on readmission review methodology, audit standards, and reimbursement considerations.
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience:

Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, Nursing, or a related field required; an additional four (4) years of directly related experience may be considered in lieu of a degree.

5 + years of progressive experience in Payment Integrity, including readmission review and DRG validation activities, required.
3+ years of people leadership experience, including direct management of teams, required.
2+ or more years of experience using Diagnosis Related Group encoder and grouper tools (for example, 3M, Optum Encoder, TruCode, TruBridge, WebSTRAT, Payment Systems Incorporated, or similar tools), required.
Experience working with payer claims systems preferred.
Demonstrated experience supporting government programs, regulatory compliance, or audit activities preferred.
Project management experience preferred.
Experience partnering with external vendors supporting Payment Integrity audit, recovery, or edit programs preferred.
Inpatient hospital documentation improvement experience preferred.

Master’s degree preferred.

License/Certification: Active Health Information Management or coding credentials required, such as RHIT, RHIA, CCS, CIC, or CCDS or Registered Nurse licensure or higher clinical qualification, in combination with a coding credential, required.

Pay Range: $87,700.00 - $157,800.00 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

Apply Now

Refine Your Search

quality improvement rn jobs in louisiana

RN Readmission Manager, Payment Integrity

Chief Flight Nurse

RN ER

Nurse Home Visitor

RN - Labor and Delivery

Registered Nurse Surgical Services

Nurse Home Visitor

CLINICAL REVIEW SPECIALIST-RN-PATIENT SAFETY/RISK MANAGEMENT

Registered Nurse (RN)

RN - NICU

Registered Nurse (RN) - ICU - Ochsner West Bank - Nights

Registered Nurse (RN) - Nights

MDS Coordinator -LPN/RN

RN Medical ICU - Jeff Hwy - Full Time - Shift of Greatest Need

Registered Nurse - ICU - Nights

RN - ICU - Night Shift - Kenner - Full Time

Registered Nurse - ICU - PRN - Day Shift - St. Bernard Parish Hospital

Nurse Home Visitor

Registered Nurse - ICU - PRN - Days - St. Bernard Parish Hospital

RN - Medical/Surgical Tele

I want to receive the latest job alert for quality improvement rn in louisiana

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected