Top 121 Claims supervisor Jobs in Utah

RN Readmission Manager, Payment Integrity
Centene Corporation —Utah
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
6d
Regional Manager- St. George
Cornerstone Residential —Saint George, UT
- Full-time
- Bilingual
- Background check
- Residential
- Health savings account
- AD&D insurance
Quick Apply
12d
Commercial Claims Manager
Trucordia —Lindon, UT
- Full-time
- Hybrid work
- Continuous improvement
- Mentoring
- Senior level
- Health savings account
- AD&D insurance
Quick Apply
Roofing Sales Project Manager
Ikon Roof —American Fork, UT
- $75,000 - $125,000 a year
- Urgently hiring
- Mid-level
- Residential
- Driver's License
- Opportunities for advancement
Quick Apply
Project Manager – Reconstruction/Restoration
LG Resources —Lindon, UT
- From $20 an hour
- Full-time
- Carpentry
- Background check
- Clean driving record
Quick Apply
13d
Automotive Parts Manager - Heritage Ford Vernal
Heritage Ford Vernal —Vernal, UT
- $80,000 - $100,000 a year
- Full-time
- Management
- Dealership
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
1d
Client Experience Manager, Pharmacy Benefits Management
CVS Health —Utah
- $46,988 - $122,400 a year
- Full-time
- Remote
- 5 years
- High school diploma or GED
- Bachelor's degree
- Health insurance
- Dental insurance
9d
Plant Safety Manager
SCHUFF STEEL CO —Lindon, UT
- Full-time
- 7 years
- Continuous improvement
- Mentoring
Manager, Medical Case Management
AmTrust Financial Services, Inc. —South Jordan, UT
- $90,000 - $140,000 a year
- Full-time
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
Case Manager, Registered Nurse
CVS Health —Utah
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- Addiction Medicine
- Health insurance
- Dental insurance
Manager, Compliance
University of Utah Health —Murray, UT
- 8 hour shift
- Bilingual
- 7 years
- Pass drug screening
- Health insurance
- Retirement plan
Product Marketing Manager - Remote
Solventum —Utah
- $143,200 - $196,900 a year
- Full-time
- Remote
- Writing skills
- Master's degree
- Bachelor's degree
- Health savings account
- Disability insurance
Sr. Manager, Pricing - Pharmacy Appeals
CVS Health —Utah
- $67,900 - $182,549 a year
- Full-time
- Remote
- 7 years
- Microsoft Access
- Office
- Health insurance
- Dental insurance
Health & Safety Manager
Sierra Forest Products —Salt Lake City, UT
- $90,000 - $110,000 a year
- Full-time
- 5 years
- Driver's License
- First Aid Certification
- Tuition reimbursement
Quick Apply
Compliance Manager
WSA Americas —Salt Lake City, UT
- HIPAA
- Mid-level
- 2 years
Quick Apply
Regional Manager
Avenue5 Residential, LLC —Salt Lake City, UT
- Overtime
- Microsoft Excel
- Microsoft Outlook
- Office
Quick Apply
7d
Senior Engineering Manager, Claims
Collective Health —Lehi, UT
- $200,000 - $250,000 a year
- Hybrid work
- Computer science
- Computer Science
- System design
- Health insurance
- 401(k)
Quick Apply
Distribution Center - Oubound Manager
Petzl —Salt Lake City, UT
- Full-time
- Mid-level
- Forklift
- US work authorization
- Profit sharing
- Paid holidays
Quick Apply
5d
Brand Activation Manager
Advantage Solutions —Salt Lake City, UT
- $68,640 - $78,000 a year
- Weekends as needed
- Microsoft Excel
- Up to 50% travel
- Computer literacy
- Opportunities for advancement
General Manager
Mesa —South Salt Lake, UT
- Full-time
- 7 years
- Senior level
- Leadership
Quick Apply

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RN Readmission Manager, Payment Integrity

Centene Corporation -
Utah

Apply Now

Job Details

Full-time
$87,700 - $157,800 a year
6 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

claims supervisor jobs in utah

RN Readmission Manager, Payment Integrity

Regional Manager- St. George

Commercial Claims Manager

Roofing Sales Project Manager

Project Manager – Reconstruction/Restoration

Automotive Parts Manager - Heritage Ford Vernal

Client Experience Manager, Pharmacy Benefits Management

Plant Safety Manager

Manager, Medical Case Management

Case Manager, Registered Nurse

Manager, Compliance

Product Marketing Manager - Remote

Sr. Manager, Pricing - Pharmacy Appeals

Health & Safety Manager

Compliance Manager

Regional Manager

Senior Engineering Manager, Claims

Distribution Center - Oubound Manager

Brand Activation Manager

General Manager

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