DRG Manager

About the role

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a DRG Manager based in the United States. This role leads the development and management of clinical payment integrity solutions, with a particular focus on MS-DRG and APR-DRG validation. You will oversee DRG audit and claims review activities designed to identify payment issues and support healthcare cost recovery. The position combines clinical and reimbursement expertise with team leadership, analytics, operational management, and client support. You will collaborate with auditors, programmers, operations, product, data, and technology teams to turn ideas into scalable solutions. A key part of the role is monitoring regulatory developments, strengthening review methodologies, and ensuring programs remain accurate and effective. You will also manage team performance, workflows, reporting, training, and complex analytical initiatives. This is an opportunity to shape clinical solutions that influence financial outcomes while developing a high-performing specialized team.

Responsibilities

• Lead the development, enhancement, and review of clinical payment solutions, including MS-DRG, APR-DRG, readmission, place-of-service, and related programs.
• Oversee the end-to-end clinical claims review process, accounting for different client configurations, workflows, requirements, and payment methodologies.
• Collaborate with programmers, auditors, operations, product leaders, data analysts, and technology teams to take DRG concepts from initial development through implementation.
• Monitor regulatory changes and evaluate the effectiveness of written rules, making updates when necessary to maintain accurate and compliant review methodologies.
• Lead and develop the DRG team by providing guidance, coaching, performance feedback, and professional development plans.
• Assign and prioritize team workloads, establish goals, coordinate daily activities, and ensure timely delivery against departmental standards.
• Monitor individual and team performance, quality results, productivity, inventory, workflows, savings, and revenue projections.
• Develop and maintain departmental policies, processes, training standards, and operational best practices.
• Analyze claims data to identify problems, trends, root causes, and