Top 216 Rn risk manager Jobs in Missouri

RN Readmission Manager, Payment Integrity
Centene Corporation —Missouri
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
11d
Registered Nurse - Case Manager
SSM Health —Bridgeton, MO
- Part-time
- Nursing
- RN License
- Hospital
- Paid parental leave
- Health insurance
Hospice Medical Social Worker MSW
One Community Hospice & Palliative Care —Independence, MO
- Full-time
- Master of Social Work
- Mid-level
- Residential
Quick Apply
5d
RN Trauma Injury Prevention Coordinator
Centerpoint Medical Center —Independence, MO
- Part-time
- Mid-level
- Pediatrics
- Experience equivalent to degree accepted
- Employee stock purchase plan
- Disability insurance
Quick Apply
RN Registered Nurse - PRN Weekends
VitalCaring Group —Springfield, MO
- Weekends as needed
- CPR Certification
- Nursing
- RN License
- Paid time off
Quick Apply
RN Registered Nurse - PRN Weekends
VitalCaring Group —Independence, MO
- Weekends as needed
- CPR Certification
- Nursing
- RN License
- Paid time off
Quick Apply
Registered Nurse - Accreditation Coordinator
US Veterans Health Administration —Jefferson Barracks, MO
- $75,487 - $153,842 a year
- Online Application
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
6d
Fraud Investigator-Kansas City, MO area
Blue Cross and Blue Shield of Kansas City —Kansas City, MO
- Full-time
- RN License
- Licensed Clinical Social Worker
- LPC
- Paid parental leave
- Paid holidays
Manager, Payment Integrity- Readmission
Centene —Missouri
- $87,700 - $157,800 a year
- Full-time
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
Quick Apply
RN Practice Manager - Infusion Services
University of Missouri Health Care —Columbia, MO
- $99,174 - $161,720 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Paid holidays
- Health insurance
Senior Compliance Administrator, Medicare Claims & Payment Integrity
Centene —Missouri
- $87,700 - $157,800 a year
- Full-time
- Remote
- Master's degree
- Presentation skills
- Bachelor's degree
- Paid holidays
- Health insurance
Clinical Risk Manager
CoxHealth —Springfield, MO
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse- Chief Nursing Informatics Officer
US Veterans Health Administration —Jefferson Barracks, MO
- $155,783 - $207,186 a year
- Online Application
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
9d
Regional Manager/Registered Nurse
Alora Supports Missouri LLC —Cape Girardeau, MO
- Full-time
- Nursing
- RN License
- Bachelor's degree
Quick Apply
4d
Program Manager - Alzheimer's Disease Center (Clinical Innovation and Implementation)
The University of Kansas Medical Center —Kansas City, MO
- $60,800 - $91,200 a year
- Full-time
- Clinic experience
- University
- Organizational skills
- Paid jury duty
- Paid holidays
Manager - Registered Nurse - Clinical Documentation Improvement
SSM Health —Missouri
- 8 hour shift
- Nursing
- RN License
- Children
- Paid parental leave
- Parental leave
Registered Nurse
US Veterans Health Administration —Kansas City, MO
- $68,432 - $120,351 a year
- Online Application
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
Manager of Care Coordination
KC CARE Health Center —Kansas City, MO
- $82,338 - $98,805 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
Quick Apply
Nurse Care Manager, RN
Burrell Behavioral Health —St. Louis, MO
- Full-time
- Nursing
- RN License
- Mid-level
- Mileage reimbursement
- Health insurance
Quick Apply
Senior Consultant - Clinical Documentation Specialist
Deloitte —Kansas City, MO
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License

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RN Readmission Manager, Payment Integrity

Centene Corporation -
Missouri

Apply Now

Job Details

Full-time
$87,700 - $157,800 a year
11 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

rn risk manager jobs in missouri

RN Readmission Manager, Payment Integrity

Registered Nurse - Case Manager

Hospice Medical Social Worker MSW

RN Trauma Injury Prevention Coordinator

RN Registered Nurse - PRN Weekends

RN Registered Nurse - PRN Weekends

Registered Nurse - Accreditation Coordinator

Fraud Investigator-Kansas City, MO area

Manager, Payment Integrity- Readmission

RN Practice Manager - Infusion Services

Senior Compliance Administrator, Medicare Claims & Payment Integrity

Clinical Risk Manager

Registered Nurse- Chief Nursing Informatics Officer

Regional Manager/Registered Nurse

Program Manager - Alzheimer's Disease Center (Clinical Innovation and Implementation)

Manager - Registered Nurse - Clinical Documentation Improvement

Registered Nurse

Manager of Care Coordination

Nurse Care Manager, RN

Senior Consultant - Clinical Documentation Specialist

I want to receive the latest job alert for rn risk manager in missouri

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