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Nurse Risk Adjustment Jobs in Arizona (NOW HIRING)

Suvida

Specialist, Quality

Phoenix, AZ · On-site

Certified Nursing Assistant * NCQA certification OR Experience Requirements * 4+ years of ... or Risk Adjustment experience in supplemental data and chart reviews * Knowledge of CMS STARS ...

Bestica Healthcare

AZ - Occupational Therapist

Tuba City, AZ · On-site

$45.25 - $59.50/hr

The nursing staff includes registered nurses, licensed practical nurses, nursing assistants ... adjustments and modification to therapy plan; promote maximum independence by selecting and ...

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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.

Director of Care Coordination (AZ & NM)

UnitedHealth Group

Phoenix, AZ • On-site

$134K - $230K/yr

Full-time

Retirement

Posted 14 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

191st of 891 rated healthcare providers

Job description

Optum is seeking a Director of Care Coordination to join our team in Arizona and New Mexico. Optum is a clinician-led care organization that is changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.
At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
The Director of Care Coordination leads a multi-state program across Arizona and New Mexico, overseeing field-based and centralized teams that support high-risk members through care management, transitions of care, medication management, behavioral health coordination, and social care support. This leader builds scalable workflows, staffing models, performance processes, and cross-functional partnerships to improve outcomes, reduce avoidable utilization, and advance value-based care performance.
Primary Responsibilities:
  • Design, launch, and scale care coordination programs for Medicare Advantage and risk-based populations
  • Build workflows, staffing models, reporting, productivity standards, and quality processes
  • Lead field-based and telephonic care coordination teams across Arizona and New Mexico
  • Oversee care management, transitions of care, readmission reduction, and support for high-risk members
  • Drive improvement in HEDIS, Stars, medication adherence, member engagement, affordability, and utilization
  • Use analytics to identify opportunities, prioritize resources, close gaps, and measure impact
  • Partner with providers, practices, pharmacy, operations, national care management, and community partners while ensuring regulatory, accreditation, and organizational compliance

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • Active, unrestricted Registered Nurse (RN) license in AZ or NM or compact license
  • Residence in AZ or NM
  • 7+ years of progressive healthcare experience in care management, population health, utilization management, or clinical operations
  • 5+ years of leadership experience managing clinical teams, programs, or operations
  • Experience leading interdisciplinary teams across multiple locations, markets, or business units
  • Experience with Medicare Advantage, value-based care, risk-bearing populations, and population health programs

Preferred Qualifications:
  • Certified Case Manager (CCM), ACM-RN, or other relevant care management certifications
  • Experience leading field-based, community-based, or multi-state care coordination programs
  • Experience supporting HEDIS, Medicare Stars, risk adjustment, and value-based care initiatives

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $134,600 - $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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