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Medicare Risk Adjustment Jobs in Missouri (NOW HIRING)

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Medicare Risk Adjustment information

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$11

$21

$37

How much do medicare risk adjustment jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for medicare risk adjustment in Missouri is $21.03, according to ZipRecruiter salary data. Most workers in this role earn between $15.10 and $25.48 per hour, depending on experience, location, and employer.

What are jobs in Medicare Risk Adjustment?

Jobs in Medicare risk adjustment include work in data analytics, consulting, insurance, and closely related industries. Your duties and responsibilities differ depending on the type of work. For example, as a Medicare risk-adjustment consultant, you provide advice and recommendations to healthcare organizations or an insurance provider on how to mitigate risk across a customer pool. Data analytics and statistics specialists gather and analyze insurance and Medicare data and documentation from hospitals, healthcare providers, and other medical care facilities that accept Medicare. This includes reviewing different types of diagnosis and comparing patient chart information. Some health care providers have in-house risk adjustment workers, while others contract with outside consulting and analytics firms.

What is the difference between Medicare Risk Adjustment vs Medicare Coding Specialist?

AspectMedicare Risk AdjustmentMedicare Coding Specialist
Primary FocusAssessing patient health risk scores for reimbursementAccurately coding medical diagnoses and procedures
Required CredentialsCertifications in risk adjustment or coding, often CPC or RHITCertifications like CPC, CCS, or RHIT
Work EnvironmentHealth plans, risk adjustment companies, healthcare providersHospitals, clinics, billing departments
Industry UsageUsed for Medicare Advantage plan reimbursementsUsed for medical billing and claims processing

While both roles involve healthcare coding and require similar certifications, Medicare Risk Adjustment focuses on evaluating patient health data to determine reimbursement levels, whereas Medicare Coding Specialists concentrate on accurately coding diagnoses and procedures for billing purposes.

What is Medicare Risk Adjustment?

Medicare Risk Adjustment is a process used by the Centers for Medicare & Medicaid Services (CMS) to adjust payments to Medicare Advantage plans based on the health status and demographic characteristics of their enrolled beneficiaries. The goal is to ensure that plans receive appropriate compensation for taking care of members with varying levels of health risk. This system uses diagnosis codes and other data to predict future healthcare costs, encouraging plans to provide comprehensive care and accurately document patient conditions.

What are some common challenges faced by professionals working in Medicare Risk Adjustment roles?

Professionals in Medicare Risk Adjustment often encounter challenges such as staying current with frequently changing CMS regulations, ensuring the accurate capture and documentation of patient diagnoses, and collaborating effectively with providers to optimize risk scores. The role requires meticulous attention to detail when reviewing medical records and coding, as well as strong communication skills to educate and support healthcare teams. Additionally, there can be pressure to meet strict deadlines for data submission and to ensure compliance with audit standards.

What are the key skills and qualifications needed to thrive in Medicare Risk Adjustment?

To excel in Medicare Risk Adjustment, you need a solid understanding of medical coding (especially ICD-10), healthcare regulations, and risk adjustment methodologies, often supported by credentials like CRC or CPC certifications. Familiarity with data analytics platforms, EHR systems, and specialized risk adjustment software is typically required. Strong attention to detail, analytical thinking, and effective communication are crucial soft skills for interpreting complex clinical data and collaborating across teams. These competencies ensure accurate risk scores, compliance with CMS requirements, and optimal financial outcomes for healthcare organizations.
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What are popular job titles related to Medicare Risk Adjustment jobs in Missouri?

For Medicare Risk Adjustment jobs in Missouri, the most frequently searched job titles are:

What job categories do people searching Medicare Risk Adjustment jobs in Missouri look for?

The top searched job categories for Medicare Risk Adjustment jobs in Missouri are:

Medicare Risk Adjustment jobs near you
Infographic showing various Medicare Risk Adjustment job openings in Missouri as of August 2026, with employment types broken down into 83% Full Time, and 17% Part Time. Highlights an 83% In-person, and 17% Remote job distribution, with an average salary of $43,742 per year, or $21 per hour.

Home Health Registered Nurse Case Manager

Alternate Solutions Health Network

Kansas City, MO • On-site

Full-time

Re-posted 6 days ago

Job description

Our culture and people are what set us apart from other post-acute care providers. We're dedicated to the growth and development of our team to set them up for success. We CARE for our patients like they are our own FAMILY.
SUMMARY
The Registered Nurse Case Manager (RNCM) assumes ultimate accountability and leadership for the assessment of the patient condition and plan of care. The RNCM provides case management, clinical care and is responsible for coordination all disciplines involved in providing quality, cost-effective and billable care through direct care and supervision of care under the direction of the physician. The RN educates patients and their family members and ensures the safety of the patient. The RN is accountable for completing accurate documentation and remains compliant with all legal rules and regulations. The RN is responsible for all practices and duties within the scope of practice as outlined by the state.
KEY RESPONSIBILITIES
  • Oversees the overall care of the patient from beginning to end of episode
  • Updates all doctor orders in patient chart accordingly
  • Notifies doctor of any significant changes of the patient's condition
  • Manages multi-disciplinary care as applicable
  • Provides skilled nursing care in a patient's home as ordered by the attending physician
  • Observes and monitors patient conditions
  • Performs OASIS assessments to develop an individualized plan of care and makes adjustments as needs change
  • Administers medication as prescribed by the physician
  • Helps decrease re-hospitalizations by front loading visits for high risk patients
  • Promotes continuity of care with appropriate admissions, transfers and discharges
  • Counsels patient and family on the disease/injury processes and how to manage
  • Incorporates patient and family in development of plan of care
  • Helps decrease re-hospitalizations by teaching the patient on preventative measures and making good decisions
  • Listens to patient and family members
  • Oversees and supervises total care of patient provided by nurse aides and LPNs
  • Evaluates the treatments and medical condition of the patient according to the plan of care
  • Determines if the level of care being provided meets the patients' needs
  • Communicates with the LPNs and nurse aides on supervisory visit results
  • Completes all clinical documentation in accordance with agency protocol and Medicare/Federal guidelines
  • Documents all aspects of treatment, assessments, and patient education
  • Maintains active RN license
  • Communicates with scheduler any changes outside the normal
  • Participates in all on-call requirements and case conferences
  • Attends in-service trainings and mandatory agency meetings
  • Drives to patient's primary location per scheduled visit.
  • Daily attendance at assigned visit locations.
  • Documents all aspects of subsequent, discharge, eval/recert/resumption of care visits within 24 hours of visits.
  • Documents all aspects of start of care visits within 24 hours of visits.
  • Completes and submits all required documentation within specified company requirements.
  • Follows plan of care as permitted within the scope of practice for a Registered Nurse.
  • Fulfills RN visits in assigned geographic location per patient need within federal and state specifications.
  • Other duties as assigned.

QUALIFICATIONS
  • Minimum of one year of experience as an RN in an acute care setting. Home care experience is desired.
  • Ability to effectively communicate and create positive impressions with patients, families, physicians and co-workers.
  • Ability to remain calm, have patience and be accommodating. Compassionate and caring while working with patients.
  • Knowledgeable on nursing best practices.
  • Ability to make appropriate nursing judgments.
  • Ability to identify a situation and handle it with the best possible solution.
  • Detail-oriented and observant.
  • Disciplined style of work ethic with the ability to prioritize and be timely
  • Ability to follow directions and work as a team member.
  • Valid driver's license and auto insurance with your name as a listed driver.

EDUCATION AND CREDENTIALS
  • Registered Nurse with current license in the state of employment.

PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without reasonable accommodations.
Knowledge
Reading, Speaking, Writing English - Constantly 66%-100%
Communications Skills - Constantly 66%-100%
Computers / PDA - Constantly 66%-100%
Physical
Walking - Frequently 34%-66%
Bending - Occasionally 2%-33%
Standing - Occasionally 2%-33%
Sitting - Frequently 34%-66%
Driving - Frequently 34%-66%
Lifting up to 50 lbs. with or without assistance - Occasionally 2%-33%
Stretching/Reaching - Occasionally 2%-33%
Climbing - Occasionally 2%-33%
Hand/finger dexterity - Constantly 66%-100%
Stooping (bend at waist) - Occasionally 2%-33%
Sensory Activities
Distinguish smell/temperature - Occasionally 2%-33%
Hearing/Seeing - Constantly 66%-100%
Talking in person - Constantly 66%-100%
Talking on the telephone - Frequently 34%-66%
Hearing in person - Constantly 66%-100%
Hearing on the telephone - Frequently 34%-66%
Vision for close work - Constantly 66%-100%
Other Sensory Activities
N/A
We'll help you put your passion for patient care to work. Apply today!
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
We are an Equal Opportunity Employer.

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