Devoted Health
Payment Integrity Clinical Readmission Manager
$73K–$125K
Remote USA · Manager · Full-time · Posted Oct 9, 2026
- Experience
- Five or more years; includes demonstrated experience reviewing inpatient hospital readmissions.
- Education
- Registered Nurse degree; desired: Bachelor of Science in Nursing or a bachelor’s degree in a related healthcare field.
About the job
Conduct clinical reviews of inpatient readmissions within 30 days, determine whether they are related to or potentially preventable, and document findings and appeal outcomes.
What you'll do
- Review claims and medical records for inpatient admissions and related readmissions, applying clinical criteria and policies.
- Prepare defensible findings, dispute responses, and appeal documentation; review additional evidence submitted during disputes and appeals.
- Collaborate on complex cases and participate in quality reviews, calibration, and process improvement.
What they ask for
- Current, active, unrestricted RN license in at least one U.S. state.
- Five or more years in clinical nursing, hospital-based care, healthcare audit, Payment Integrity, utilization management, quality review, or a related healthcare environment, including experience reviewing inpatient readmissions.
- Strong inpatient clinical knowledge and experience reviewing and synthesizing medical records.
- Experience applying clinical criteria, policies, regulatory guidance, or review methodologies and preparing clear clinical determinations.
Nice to have
- Bachelor of Science in Nursing or a bachelor’s degree in a related healthcare field.
- Experience conducting readmission reviews, handling appeals, or familiarity with payer criteria, inpatient coding, DRG methodology, automation, or AI-supported review workflows.
Pay
$73,000 - 125,000 USD annually (base salary)
Tools
electronic medical records, claims information, clinical review systems, audit workflow platforms
AI focus
Familiarity with automation, artificial intelligence, or other technology used to support clinical audit and review workflows is desired.
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