Centene Corporation is seeking a Licensed RN with a Coding Credential to lead Payment Integrity initiatives around potentially preventable readmissions and DRG validation. You will manage auditors and clinical staff, ensuring accurate determinations and alignment with policies and regulations.
You will guide cross-functional teams across Health Plans, Finance, Compliance, and Legal to drive program performance and ensure compliant reimbursement under MS-DRG/APR-DRG methodologies.