Centene Corp

Manager, Clinical & Coding Review

Centene Corp • $107K — $199K *
US-Anywhere
+ 3 other locationsRemote
Healthcare
5 - 7 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Associate's Degree in health information management, Nursing, or related field required
  • 5+ years of managerial/supervisory experience required
  • 8+ years in complex medical claim review required
  • 3+ years in DRG review and Clinical Documentation Improvement required
  • Proficiency in ICD-10-CM/PCS, MS-DRG, APR-DRG, and other review types required

Responsibilities

  • Monitor and optimize business processes for accuracy and compliance in billing and claims payment.
  • Lead and mentor high-performing teams in advanced coding and clinical validation reviews.
  • Develop and maintain standardized documentation for consistent review methodologies.
  • Provide strategic leadership to foster a culture of quality and continuous improvement.
  • Collaborate with cross-functional stakeholders to identify process improvement opportunities.
  • Direct team operations by setting goals and maintaining transparent communication.
  • Oversee the end-to-end audit program lifecycle, ensuring compliance with all regulatory requirements.

Benefits

  • Comprehensive health insurance
  • 401K and stock purchase plans
  • Tuition reimbursement
  • Paid time off plus holidays
  • Flexible work schedules including remote options
Full Job Description
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT

This is a remote role with up to 25% travel

Position Purpose:
Provides strategic leadership for teams performing advanced, complex claim reviews to ensure accuracy, regulatory compliance, and achievement of payment integrity goals. This role accelerates program growth by analyzing performance trends, standardizing processes, and implementing consistent review methodologies. Leveraging deep expertise in ICD-10, CPT/HCPCS coding, and clinical guidelines, the manager delivers actionable insights that shape operational strategies and drive informed decision-making. Additionally, this position cultivates a high-performance culture focused on continuous improvement, accountability, and professional development across both the team and the broader program.

  • Monitors and optimizes business processes and systems to ensure accuracy, compliance, and integrity in billing and claims payment.
  • Leads and mentors high-performing teams conducting advanced coding and clinical validation reviews.
  • Develops and maintains standardized documentation that supports business objectives and ensures consistency in review methodologies and outcomes.
  • Provides strategic leadership to review teams, fostering a culture of quality, accountability, and continuous improvement.
  • Collaborates with cross-functional stakeholders to identify process improvement opportunities and champion innovative solutions.
  • Directs team operations by assigning priorities, setting goals, and coordinating daily activities. Maintain transparent communication through regular one-on-one and team meetings.
  • Establishes and oversees the end-to-end audit program lifecycle within Payment Integrity by setting strategic audit direction, managing and developing teams, and ensuring full compliance with all regulatory, contractual, and organizational requirements.
  • Applys advanced expertise in ICD-10 coding, clinical guidelines, and Centene/Health Plan policies, incorporating updates from CMS, state regulations, and contractual obligations to guide review outcomes and operational decisions.
  • Drives documentation initiatives that align with business objectives, ensuring consistency and identifying high-value review opportunities within the complex review roadmap.
  • Analyzes audit trends and DRG adjustments to inform scalable program development and identify emerging review opportunities within DRG and other review types.
  • Oversees program expansion by implementing new complex review types, facilitating cross-departmental collaboration, and integrating robust review protocols for audit operations.
  • Performs other duties as assigned.
  • Complies with all policies and standards.

Education/Experience:

  • Associate's Degree in health information management, Nursing, or a related field required
  • 5+ years Managerial/Supervisory experience required
  • 8+ years Complex medical claim review experience required
  • 3+ years DRG review experience, Clinical Documentation Improvement experience required
  • Proficiency ICD-10-CM/PCS, MS-DRG, APR-DRG required
  • Proficiency Readmission, APC, EAPG, and other review types required


Licenses/Certifications:

RHIA - Registered Health Information Administrator required OR

RHIT - Registered Health Information Technician required OR

CCS-Certified Coding Specialist required OR

Clinical Inpatient Coder (CIC) required OR

Certified Clinical Documentation Specialist (CCDS) required OR

CDIP - Clinical Documentation Improvement Professional preferred OR

RN - Registered Nurse - State Licensure and/or Compact State Licensure in combination with a coding credential preferred

Pay Range: $107,700.00 - $199,300.00 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.

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

Stay Connected with Centene Careers

Keep up to date with the latest career tips, insider perspectives, and industry-leading insights—all from the people who work at Centene Corp. Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding opportunities that await you at Centene Corp.

SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Healthcare
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ
CNC
* Ladders Estimates

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