Top 4575 Medical records manager Jobs in Maryland

RN Readmission Manager, Payment Integrity
Centene Corporation —Maryland
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
9d
PROGRAM MANAGER II
State of Maryland - DPSCS Internal Investigation Unit —Howard County, MD
- $87,253 - $137,603 a year
- Online Application
- 7 years
- Office
- Driver's License
- Paid parental leave
- Health insurance
1d
Site Manager - HIM Operations
Johns Hopkins Health System —Columbia, MD
- Full-time
- Hospital
- Customer service
- Mid-level
Lab Animal Services Manager II
Frederick National Laboratory —Bethesda, MD
- $93,800 - $134,285 a year
- Weekends as needed
- Microsoft Excel
- Microsoft Outlook
- Management
Manager, Corporate IT Audit
CVS Health —Maryland
- $54,300 - $145,860 a year
- Full-time
- Remote
- CPA
- Bachelor's degree
- Travel
- Health insurance
- Dental insurance
IS Program Manager
Children's National Hospital —Silver Spring, MD
- $131,060.80 - $218,441.60 a year
- Full-time
- Computer Science
- 5 years
- Master's degree
Records and Property Management Specialist
Noblis —Bethesda, MD
- $90,700 - $141,775 a year
- Full-time
- 5 years
- Office
- High school diploma or GED
- Health insurance
- Tuition reimbursement
Medical Support Program Manager
Terrestris Global Solutions —Bethesda, MD
- $80,000 - $90,000 a year
- Full-time
- Mid-level
- High school diploma or GED
- Team management
- Tuition reimbursement
- Retirement plan
Quick Apply
Sr Manager - Corporate Compliance
CVS Health —Maryland
- $82,940 - $182,549 a year
- Full-time
- Remote
- 5 years
- Research
- Master's degree
- Health insurance
- Dental insurance
Quality Practice Liaison (Must be licensed in Arizona or Multi-State)
CVS Health —Maryland
- $54,095 - $155,538 a year
- Full-time
- Remote
- Nursing
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
8d
HIM Team Lead, BWMC, Day
University of Maryland Medical System —Glen Burnie, MD
- Full-time
- Customer service
- Computer literacy
- HIPAA
8d
Next Generation Sequencing Lab Manager, GeneDx
GeneDx, Inc —Gaithersburg, MD
- Full-time
- Bachelor of Science
- Supervising experience
- Bachelor's degree
Quick Apply
Compliance Program Manager
Johns Hopkins Health System —Baltimore, MD
- Full-time
- Management
- Hospital
- 5 years
Assistant Vice President, Facilities
University of Maryland Global Campus —Adelphi, MD
- $190,000 - $210,000 a year
- Full-time
- Customer service
- 5 years
- High school diploma or GED
- AD&D insurance
- Paid holidays
Senior Consultant - Clinical Documentation Specialist
Deloitte —Baltimore, MD
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Senior Program Manager / Project Manager - Medicaid Claims
CVS Health —Maryland
- $106,605 - $284,280 a year
- Full-time
- Remote
- Bachelor's degree
- Mentoring
- Fair chance
- Health insurance
- Dental insurance
Disability Program Manager (Program Manager I, Grade N23)
Montgomery County Government —Rockville, MD
- $78,929 - $102,514 a year
- Email
- Experience working with individuals with disabilities
- HIPAA
- Mid-level
- Wellness program
- Paid parental leave
11d
Sr Talent Development Specialist
Textron Systems —Hunt Valley, MD
- $88,200 - $133,000 a year
- Full-time
- Office
- Project management
- Continuous improvement
- Wellness program
- Paid parental leave
Quality Assurance Specialist, Laboratory
University of Maryland Medical System —Baltimore, MD
- $40.61 - $60.96 an hour
- Part-time
- Mid-level
- Bachelor's degree
- Children
10d
Resident Construction Manager - Sewer Pumping Station Facilities
Whitman, Requardt & Associates, LLP —Baltimore, MD
- Overtime
- Background check
- Clean driving record
- Microsoft Excel
- Paid holidays
- Disability insurance

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RN Readmission Manager, Payment Integrity

Centene Corporation -
Maryland

Apply Now

Job Details

Full-time
$87,700 - $157,800 a year
9 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

medical records manager jobs in maryland

RN Readmission Manager, Payment Integrity

PROGRAM MANAGER II

Site Manager - HIM Operations

Lab Animal Services Manager II

Manager, Corporate IT Audit

IS Program Manager

Records and Property Management Specialist

Medical Support Program Manager

Sr Manager - Corporate Compliance

Quality Practice Liaison (Must be licensed in Arizona or Multi-State)

HIM Team Lead, BWMC, Day

Next Generation Sequencing Lab Manager, GeneDx

Compliance Program Manager

Assistant Vice President, Facilities

Senior Consultant - Clinical Documentation Specialist

Senior Program Manager / Project Manager - Medicaid Claims

Disability Program Manager (Program Manager I, Grade N23)

Sr Talent Development Specialist

Quality Assurance Specialist, Laboratory

Resident Construction Manager - Sewer Pumping Station Facilities

I want to receive the latest job alert for medical records manager in maryland

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