Top 2021 Works manager Jobs in Rhode Island

RN Readmission Manager, Payment Integrity
Centene Corporation —Rhode Island
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
9d
Manager Data & Integration Platforms
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $151,900 - $243,100 a year
- Full-time
- Remote
- Computer Science
- Office
- 3 years
- Loan repayment program
- Dental insurance
Senior Manager, iCasino Operations
Bally's Interactive —Providence, RI
- $100,000 - $130,000 a year
- Remote
- 5 years
- Senior level
- Commercial
Quick Apply
1d
Communications Account Manager
CVS Health —Rhode Island
- $54,300 - $159,120 a year
- Full-time
- Remote
- Licensed Clinical Social Worker
- Mid-level
- 3 years
- Health insurance
- Dental insurance
9d
Senior Manager-Agile Practice Management
CVS Health —Rhode Island
- $106,605 - $284,280 a year
- Full-time
- Remote
- Research
- Bachelor's degree
- Mentoring
- Health insurance
- Dental insurance
3d
Next 150 Operations Manager
Next 150 Construction, LLC —Providence, RI
- $215,000 - $300,000 a year
- Full-time
- Construction site
- Engineering
- 11+ years
Management Analyst (Audits and Agreements Manager)
US Military Treatment Facilities under DHA —Newport, RI
- $101,375 - $131,790 a year
- Overtime
- Background check
- Pass drug screening
- Mid-level
8d
Contacts Manager
CVS Health —Woonsocket, RI
- $60,300 - $145,860 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- 3 years
- Health insurance
- Dental insurance
7d
Manager, Proposals
CVS Health —Rhode Island
- $60,300 - $145,860 a year
- Full-time
- Remote
- Bachelor's degree
- Fair chance
- Budgeting
- Health insurance
- Dental insurance
1d
Manager, Solutions Delivery
CVS Health —Rhode Island
- $83,430 - $203,940 a year
- Full-time
- Remote
- 5 years
- Bachelor's degree
- Fair chance
- Health insurance
- Dental insurance
Business Operations Manager
Nautilus Defense —Pawtucket, RI
- $80,000 - $110,000 a year
- Full-time
- Office
- 3 years
- Recruiting
Sales Manager at Castle Hill Inn
CASTLE HILL INC —Newport, RI
- $60,000 - $62,000 a year
- Customer service
- Mid-level
- Hotel
- AD&D insurance
- Paid holidays
District Sales Manager - Northern New York and New England
Hohmann & Barnard, Inc. —Providence, RI
- $88,000 - $132,000 a year
- Email
- Background check
- Microsoft Excel
- Construction site
- Travel reimbursement
- Health savings account
Construction Project Manager
Bentley Companies —Warwick, RI
- $110,000 - $140,000 a year
- Full-time
- Microsoft Excel
- Construction site
- 5 years
- Health insurance
- Dental insurance
Quick Apply
4d
Finance Manager
HappyNest —East Greenwich, RI
- $90,000 - $100,000 a year
- Full-time
- Microsoft Excel
- CPA
- Mid-level
- Health insurance
- 401(k)
Quick Apply
Sr IT Infrastructure Engineer/Lead IT Infrastructure Engineer
AIPSO —Johnston, RI
- $92,300 - $176,000 a year
- Full-time
- Computer science
- 7 years
- Computer Science
Quick Apply
Weekend RN Supervisor
Riverview Rehabilitation and Healthcare Center —Coventry, RI
- $38 - $60 an hour
- Part-time
- CPR Certification
- Skilled nursing facility
- RN License
- Dental insurance
- Tuition reimbursement
Quick Apply
10d
Case Manager Registered Nurse, Case Management
South County Health —Wakefield, RI
- Part-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
ASCP Certified Phlebotomy Team Leader
South County Health —Wakefield, RI
- $28 - $36 an hour
- Full-time
- Hospital
- BLS Certification
- Inpatient
- Health insurance
- Dental insurance
Quick Apply
Beverage Manager (Catering)
Blackstone Caterers —Middletown, RI
- $80,000 - $85,000 a year
- Weekends as needed
- Background check
- Customer service
- Mid-level
- Paid training
- Health insurance
Quick Apply

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RN Readmission Manager, Payment Integrity

Centene Corporation -
Rhode Island

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

works manager jobs in rhode island

RN Readmission Manager, Payment Integrity

Manager Data & Integration Platforms

Senior Manager, iCasino Operations

Communications Account Manager

Senior Manager-Agile Practice Management

Next 150 Operations Manager

Management Analyst (Audits and Agreements Manager)

Contacts Manager

Manager, Proposals

Manager, Solutions Delivery

Business Operations Manager

Sales Manager at Castle Hill Inn

District Sales Manager - Northern New York and New England

Construction Project Manager

Finance Manager

Sr IT Infrastructure Engineer/Lead IT Infrastructure Engineer

Weekend RN Supervisor

Case Manager Registered Nurse, Case Management

ASCP Certified Phlebotomy Team Leader

Beverage Manager (Catering)

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