Top 51 Remote quality improvement rn Jobs in North Carolina

RN Readmission Manager, Payment Integrity
Centene Corporation —North Carolina
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
7d
Quality Perform Specialist Clinical
Amerihealth Caritas —Raleigh, NC
- Full-time
- Hybrid work
- Microsoft Excel
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quality Management Specialist III - Population Health
TRILLIUM HEALTH RESOURCES —North Carolina
- $68,890 - $92,138 a year
- Full-time
- Remote
- LMFT
- Nursing
- RN License
- Paid holidays
- Health insurance
Quick Apply
4d
RN Care Manager - Primarily remote - Greensboro, NC
Cityblock Health —Greensboro, NC
- $85,000 - $95,000 a year
- Full-time
- Nursing
- Current TB test
- Mid-level
- Health insurance
- Paid time off
Clinical Supervisor, Virtual Clinical Operations
Interwell Health —Charlotte, NC
- Full-time
- RN License
- HIPAA
- Mid-level
RN Care Manager -Up to 85% Remote - New Hanover County/ Brunswick County
Cityblock Health —Wilmington, NC
- $71,000 - $90,500 a year
- Full-time
- Hybrid work
- Nursing
- Current TB test
- Mid-level
- Health insurance
- Paid time off
Central Risk Manager (RBQM & Central Monitoring) - Remote: United States or Canada
Syneos - Clinical and Corporate - Prod —North Carolina
- $95,000 - $175,700 a year
- Full-time
- Remote
- Nursing
- English
- Business development
- Employee stock purchase plan
- Health insurance
Central Risk Manager (RBQM & Central Monitoring) - Remote: United States or Canada
サイネオス・ヘルス —North Carolina
- $95,000 - $175,700 a year
- Remote
- Nursing
- English
- Business development
- Employee stock purchase plan
- Health insurance
Care Management Nurse Consultant, RN (Hickory/Forest City, NC)
Partners Behavioral Health Management —Hickory, NC
- Full-time
- Spanish
- Nursing
- Microsoft Excel
- Paid holidays
- Disability insurance
Patient Care Navigator- Chronic Care Management & Patient Monitoring
On Track Technologies Incorporated —Raleigh, NC
- $18 - $45 an hour
- Overtime
- RN License
- Mid-level
- LPN
- Paid training
- Paid holidays
Quick Apply
RN
Carteret Health Care —Morehead City, NC
- PRN
- Nursing
- RN License
- BLS Certification
Quick Apply
RN Cardiology
Carteret Health Care —Morehead City, NC
- PRN
- Nursing
- RN License
- BLS Certification
Quick Apply
Registered Nurse
GT Independence —Greensboro, NC
- Nursing
- RN License
- Mid-level
- Paid time off
Quick Apply
1d
Emergency Department Nurse Manager
Sentara Albemarle Regional Medical Center, LLC —Elizabeth City, NC
- Full-time
- Nursing
- RN License
- 3 years
- 403(b) matching
- Paid parental leave
Quick Apply
Facility Revenue Manager, Ambulatory Surgery Centers - Remote, M-F
Duke Health —Durham, NC
- Full-time
- Remote
- Surgery
- Writing skills
- System design
- Employee assistance program
Primary and Palliative Care Registered Nurse (RN) or LPN PRN
VIA Health Partners —Charlotte, NC
- Full-time
- CPR Certification
- Nursing
- RN License
Quick Apply
Nurse Navigator
TandemStride, Inc. —Chapel Hill, NC
- Full-time
- Hybrid work
- Background check
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
Clinical Manager, Advocacy and Navigation
Well Dot, Inc —Chapel Hill, NC
- $80,000 - $90,000 a year
- Full-time
- RN License
- Licensed Clinical Social Worker
- HIPAA
Quick Apply
7d
TCM Care Manager - Alliance Catchment Area
Healthkeeperz —Raleigh, NC
- Full-time
- Hybrid work
- Experience working with individuals with developmental disabilities
- Nursing
- RN License
Quick Apply
Registered Nurse Manager-Perioperative
US Veterans Health Administration —Fayetteville, NC
- $94,918 - $158,239 a year
- Online Application
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
6d

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remote quality improvement rn jobs near north carolina

RN Readmission Manager, Payment Integrity

Centene Corporation -
North Carolina

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

remote quality improvement rn jobs in north carolina

RN Readmission Manager, Payment Integrity

Quality Perform Specialist Clinical

Quality Management Specialist III - Population Health

RN Care Manager - Primarily remote - Greensboro, NC

Clinical Supervisor, Virtual Clinical Operations

RN Care Manager -Up to 85% Remote - New Hanover County/ Brunswick County

Central Risk Manager (RBQM & Central Monitoring) - Remote: United States or Canada

Central Risk Manager (RBQM & Central Monitoring) - Remote: United States or Canada

Care Management Nurse Consultant, RN (Hickory/Forest City, NC)

Patient Care Navigator- Chronic Care Management & Patient Monitoring

RN

RN Cardiology

Registered Nurse

Emergency Department Nurse Manager

Facility Revenue Manager, Ambulatory Surgery Centers - Remote, M-F

Primary and Palliative Care Registered Nurse (RN) or LPN PRN

Nurse Navigator

Clinical Manager, Advocacy and Navigation

TCM Care Manager - Alliance Catchment Area

Registered Nurse Manager-Perioperative

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