RN Readmission Manager with Coding Credential

Job Summary

Leading Payment Integrity initiatives, the full-time RN Readmission Manager with Coding Credential will oversee a team focused on potentially preventable readmissions, ensuring payment accuracy and compliance with internal policies and regulatory requirements in a remote setting.

Key responsibilities

• Lead and manage Payment Integrity initiatives related to readmissions, cost recovery, and payment accuracy
• Collaborate with cross-functional teams to design and monitor readmission and DRG-related strategies
• Provide operational oversight and ensure compliance with regulations and internal policies governing audit activities

Required qualifications

• Bachelor's degree in Healthcare Administration, Nursing, or a related field required; relevant experience may substitute for degree
• 5+ years of progressive experience in Payment Integrity, including readmission review and DRG validation
• 3+ years of people leadership experience managing teams
• 2+ years of experience with Diagnosis Related Group encoder and grouper tools
• Active RN licensure or higher clinical qualification combined with a coding credential required