Top 532 Insurance claims manager Jobs in Virginia

RN Readmission Manager, Payment Integrity
Centene Corporation —Virginia
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
11d
MPPS Policy Deviations Senior Manager
CVS Health —Richmond, VA
- $67,900 - $182,549 a year
- Full-time
- Nursing
- 5 years
- Bachelor's degree
- Health insurance
- Dental insurance
Healthcare Market Finance Lead
Humana —Virginia
- $104,000 - $143,000 a year
- Full-time
- CPA
- Office
- Master's degree
- Paid parental leave
- Paid holidays
Registered Nurse - Patient Safety/Risk Manager (Fredericksburg HCC)
US Veterans Health Administration —Fredericksburg, VA
- $82,309 - $161,732 a year
- Online Application
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
3d
Manager, Dental Contract Negotiations
CVS Health —Virginia
- $54,300 - $145,860 a year
- Full-time
- Remote
- Microsoft Excel
- 3 years
- Analysis skills
- Health insurance
- Dental insurance
Risk Manager
University of Virginia —Manassas, VA
- $43.16 - $72.89 an hour
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Heavy Civil Project Manager
Thalle Construction Company —Virginia
- Civil engineering
- Construction site
- Bachelor of Science
- Paid holidays
- Disability insurance
Quick Apply
Registered Nurse Case Manager - Field in Northern Virginia
CVS Health —Sterling, VA
- $60,522 - $129,615 a year
- Full-time
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
Registered Nurse Case Manager - Field in Northern Virginia
CVS Health —Vienna, VA
- $60,522 - $129,615 a year
- Full-time
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
Construction Safety Manager
Virginia Paving Company —Chantilly, VA
- Up to $90,000 a year
- 8 hour shift
- Spanish
- 7 years
- Construction site
- AD&D insurance
- Paid holidays
Quick Apply
Construction Mgr
Virginia Department of Transportation —Harrisonburg, VA
- Full-time
- CPR Certification
- Civil engineering
- Construction site
4d
Operations Manager - Civil Engineering Construction
Construction Demathieu & Bard (CDB) inc. —Alexandria, VA
- Civil engineering
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Mitigation Project Manager
ServPro of North Stafford County —Springfield, VA
- $60,000 - $75,000 a year
- Full-time
- Background check
- Clean driving record
- Mid-level
- Paid time off
Quick Apply
Contract and Procurement Manager
County of Orange, VA —Orange, VA
- $72,000 - $88,824 a year
- Full-time
- Background check
- 5 years
- Writing skills
- Health savings account
- Disability insurance
Quick Apply
Project Manager - Site Development Construction
William A. Hazel, Inc. —Chantilly, VA
- From $120,000 a year
- Extended hours
- Civil engineering
- Construction site
- 5 years
- Health savings account
- Health insurance
Quick Apply
Heavy Civil Project Manager - Roadway
ilocatum —Richmond, VA
- $140,000 - $180,000 a year
- Full-time
- Clean driving record
- Civil engineering
- Construction site
- Paid holidays
- Disability insurance
Quick Apply
Human Resources Manager
Sturgeon Transport Inc —Brandy Station, VA
- $66,182.94 - $79,704.18 a year
- Full-time
- Management
- OSHA
- 5 years
- Paid holidays
- Health insurance
Quick Apply
Quality Assurance Manager/Specialist (Entry Level to SME) TS/SCI with Poly REQUIRED
CGI Group, Inc. —Arlington, VA
- $89,600 - $204,000 a year
- ERP systems
- Office
- Master's degree
- Paid parental leave
- Paid holidays
Registered Nurse Case Manager - Field in Northern Virginia
CVS Health —Springfield, VA
- $60,522 - $129,615 a year
- Full-time
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
Sales Manager
Ashburn Roofing —Winchester, VA
- Full-time
- Mid-level
- Recruiting
- In-person
Quick Apply
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RN Readmission Manager, Payment Integrity

Centene Corporation -
Virginia

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

insurance claims manager jobs in virginia

RN Readmission Manager, Payment Integrity

MPPS Policy Deviations Senior Manager

Healthcare Market Finance Lead

Registered Nurse - Patient Safety/Risk Manager (Fredericksburg HCC)

Manager, Dental Contract Negotiations

Risk Manager

Heavy Civil Project Manager

Registered Nurse Case Manager - Field in Northern Virginia

Registered Nurse Case Manager - Field in Northern Virginia

Construction Safety Manager

Construction Mgr

Operations Manager - Civil Engineering Construction

Mitigation Project Manager

Contract and Procurement Manager

Project Manager - Site Development Construction

Heavy Civil Project Manager - Roadway

Human Resources Manager

Quality Assurance Manager/Specialist (Entry Level to SME) TS/SCI with Poly REQUIRED

Registered Nurse Case Manager - Field in Northern Virginia

Sales Manager

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