Manager, Clinical Review

Centene Corporation

Centene healthcare integrity manager leading clinical reviews and fraud, waste, and abuse investigations. Managing clinical investigators, audits, coding research, provider education, and cost-savings validation remotely in Missouri.

Posted 8/18/2026full-timeRemote • Montana • 🇺🇸 United StatesMid-LevelSenior💰 $87,700 - $157,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical coding, clinical review processes, and fraud detection while effectively managing cross-functional teams and collaborating with healthcare providers. Proficient in developing strategies for billing accuracy and compliance with healthcare standards.

Highest-signal resume keywords

Medical CodingFraud, Waste & Abuse ManagementCPT Code BillingTeam LeadershipClinical Review

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical TerminologyCoding ResearchAudit ProcessesCost Savings AnalysisClinical Expertise

Soft Skills

CollaborationCommunicationTrainingProblem-Solving

Certifications & Qualifications

Certified Professional CoderRNLPN

Industry Keywords

Healthcare IntegrityBilling PracticesMedical PolicyClinical DenialsCompliance

About the role

Key responsibilities & impact

Manage the resources and results of clinical reviews resulting from providers or claims identified for potential fraud, waste and/or abuse
Manage review and audit processes for inappropriate billing practices
Develop medical strategies to correct billing issues
Review audit reports for accuracy and completeness
Present findings to Upper Management
Collaborate with providers and conduct continuous educational training on appropriate billing patterns
Support legal actions taken by the corporation, state and federal governments
Oversee implementation of improvement opportunities for effective and efficient audit processes
Collaborate with the medical management department to help define medical policy based on coding research and medical-record review
Oversee and review cost savings analysis
Meet with Medical Directors to validate medical decisions and track cost savings based on clinical denials
Lead and develop a team of clinical investigators
Review and evaluate complex Fraud, Waste & Abuse cases
Apply clinical expertise to identify trends, risks, and potential concerns
Partner with providers and internal stakeholders on complex cases
Support healthcare integrity and appropriate utilization of services
Perform other duties as assigned
Comply with all policies and standards

Requirements

What you’ll need

Bachelor's Degree in Nursing, a related field, or equivalent experience required for Physical Health
5+ years of medical coding and/or nursing experience required for Physical Health
Strong medical terminology and research techniques required for Physical Health
Knowledge of CPT code billing required
Previous experience managing cross-functional teams on large-scale projects or supervisory experience, including hiring, training, assigning work, and managing staff performance, required
Clinical experience in a hospital or clinic setting, emergency room, and/or physician office preferred for Physical Health
Certified Professional Coder, RN, or LPN preferred/considered a plus
Ability to review medical records and conduct coding research
Ability to manage clinical investigators and complex healthcare integrity cases
Ability to collaborate with providers, Medical Directors, internal stakeholders, and legal entities
Compliance with all policies and standards

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off
Holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation
Workplace flexibility
Accommodation support