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Nurse Risk Adjustment Jobs in Arizona (NOW HIRING)

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Nurse Risk Adjustment information

What is a nurse risk adjustment?

Nurse risk adjustment nurses are specialized healthcare professionals who review patient medical records to ensure accurate documentation of diagnoses and health conditions. Their work supports the risk adjustment process, which helps health plans and providers receive appropriate compensation based on the health status of their patient populations. These nurses use their clinical expertise to identify missing or undocumented conditions, collaborate with providers to improve documentation accuracy, and help ensure compliance with federal guidelines. By doing so, they play a key role in improving patient care quality and the financial health of healthcare organizations.

What are the key skills and qualifications needed to thrive as a nurse risk adjustment?

To thrive as a Nurse Risk Adjustment, you need a solid background in clinical nursing, comprehensive knowledge of medical coding (especially ICD-10), and familiarity with risk adjustment methodologies, typically supported by RN licensure and experience in case management or chart review. Proficiency with electronic health record (EHR) systems, coding software, and sometimes a Certified Risk Adjustment Coder (CRC) credential is valuable. Attention to detail, analytical thinking, and strong communication skills help nurses accurately review documentation and collaborate with providers. These skills ensure accurate coding and risk stratification, which directly impact healthcare reimbursement and quality reporting.

How does a nurse risk adjustment professional typically collaborate with coding and provider teams to ensure accurate risk scoring?

Nurse Risk Adjustment professionals often work closely with medical coders and healthcare providers to review patient documentation and ensure diagnoses are captured accurately for risk adjustment purposes. They may participate in interdisciplinary meetings, provide education to providers on documentation best practices, and clarify coding queries. This collaborative approach helps optimize the accuracy of risk scores, which impacts reimbursement and quality metrics. Effective communication and teamwork are essential in this role to support compliance and achieve organizational goals.

What is the difference between Nurse Risk Adjustment vs Nurse Case Manager?

AspectNurse Risk AdjustmentNurse Case Manager
CertificationsRN license, risk adjustment trainingRN license, case management certification
Work EnvironmentInsurance companies, healthcare analyticsHospitals, clinics, patient homes
Employer & IndustryHealth plans, insurance providersHealthcare providers, hospitals

While both roles require RN licensure, Nurse Risk Adjustment focuses on analyzing and coding patient data for insurance risk models, whereas Nurse Case Managers coordinate patient care and manage treatment plans. Understanding these differences helps professionals choose the right career path within healthcare and insurance industries.

What are popular job titles related to Nurse Risk Adjustment jobs in Arizona?

For Nurse Risk Adjustment jobs in Arizona, the most frequently searched job titles are:

What job categories do people searching Nurse Risk Adjustment jobs in Arizona look for?

The top searched job categories for Nurse Risk Adjustment jobs in Arizona are:

What cities in Arizona are hiring for Nurse Risk Adjustment jobs?

Cities in Arizona with the most Nurse Risk Adjustment job openings:

Nurse Risk Adjustment jobs near you
Infographic showing various Nurse Risk Adjustment job openings in Arizona as of August 2026, with employment types broken down into 72% Full Time, 14% Part Time, 6% Temporary, and 8% Contract. Highlights an 88% In-person, and 12% Remote job distribution.

CDI & Risk Adjustment Specialist

Hospice of the Valley

Phoenix, AZ

$33 - $44.25/hr

Full-time

PTO

Posted 6 days ago

Hospice Of The Valley (Arizona) rating

7.8

Company rating: 7.8 out of 10

Based on 24 frontline employees who took The Breakroom Quiz

12th of 45 rated hospices

Job description

Join Arizona’s largest, most prominent not-for-profit hospice, serving the valley since 1977.

Hospice of the Valley is a national leader in hospice care and has been serving the Phoenix metropolitan area since 1977.  A mission-driven, not-for-profit organization, Hospice of the Valley employs compassionate, skilled professionals who are committed to excellence, enjoy teamwork, and contribute daily to our mission and culture of caring. Team members experience a friendly, supportive atmosphere, leadership support, autonomy, flexibility and the privilege of doing meaningful, rewarding work.

Benefits:

  • Supportive work environment with a culture of caring for patients and one another.
  • Competitive wages and excellent benefit program.
  • Generous Paid Time Off.
  • Flexible schedules for work/life balance

Position Profile

The CDI & Risk Adjustment Specialist is responsible for strengthening clinical documentation integrity, improving risk adjustment accuracy, and supporting reliable coding outcomes across the patient population. This senior individual contributor role carries primary accountability for ensuring documentation accurately reflects patient complexity, severity of illness, and applicable risk adjustment requirements. The role serves as a critical link between clinical care, documentation standards, and accurate coding through comprehensive chart review, provider collaboration, and targeted education.

Responsibilities

  • Promotes clinical documentation integrity and accurate coding outcomes.
  • Facilitates provider query, collaboration, and clarification.
  • Conducts quality chart review and audits.
  • Promotes provider education and documentation improvement.
  • Facilitates continuous improvement and assures compliance with documentation and risk adjustment requirements.
  • Strong verbal and written communication skills, including the ability to explain documentation and coding concepts clearly and professionally.
  • High proficiency in Electronic Health Record (EHR) platforms and data analytic tools.
  • Ability to build effective working relationships with providers, clinical staff, coders, compliance partners, and operational leaders.
  • Strong analytical skills with the ability to interpret clinical information, identify documentation gaps, and evaluate coding support.
  • High attention to detail, accuracy, confidentiality, and follow-through.
  • Ability to organize work, manage competing priorities, meet deadlines, and perform independently as a senior individual contributor.

Minimum Qualifications

  • Bachelor’s degree in nursing, health information management, healthcare administration, coding, or a related healthcare field preferred; equivalent relevant experience may be considered.
  • Minimum of 3–5 years dedicated experience in clinical documentation integrity, risk adjustment, and HCC coding.
  • Certified Risk Adjustment Coder (CRC) designation from the AAPC required.
  • Experience reviewing medical records for documentation specificity, diagnosis support, coding accuracy, and risk adjustment opportunity identification.
  • Deep understanding of CMS risk adjustment models, HCC categories, ICD-10-CM coding concepts, clinical documentation standards, and provider query practices.
  • Expertise in use of Chronic Care Management and Principal Care Management Codes.
  • Strong clinical knowledge of anatomy, physiology, and pharmacology to effectively evaluate disease progression.

Preferred Qualifications

  • Experience collaborating with providers, clinical leaders, coders, compliance teams, or revenue cycle teams.
  • Registered Nurse.
  • Additional certifications such as CCDS (Certified Clinical Documentation Specialist) or CDIP (Certified Documentation Improvement Practitioner.)

 Hospice of the Valley is an equal employment opportunity employer. EOE/M/F/D/V

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