The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
Nurse Navigator, BHMG Cardiology, FT, 8:30A-5P
$80K - $107K/yr
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
Nurse Navigator, BHMG Cardiology, FT, 8:30A-5P
$80K - $107K/yr
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
Nurse Navigator, BHMG Cardiology, FT, 8:30A-5P
$80K - $107K/yr
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
Nurse Navigator, BHMG Cardiology, FT, 8:30A-5P
$80K - $107K/yr
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
ACN Physician
Debary, FL · On-site
$180K - $210K/yr
Medical
Dental
Vision
PTO
Extensive Knowledge of Medicare Advantage Plans, HEDIS Measures, Medicare Risk Adjustment (MRA ... Collaborate with Advanced Practice Providers, Nurses, Care Coordinators, and Administrative Staff ...
ACN Physician
Debary, FL · On-site
$180K - $210K/yr
Medical
Dental
Vision
PTO
Extensive Knowledge of Medicare Advantage Plans, HEDIS Measures, Medicare Risk Adjustment (MRA ... Collaborate with Advanced Practice Providers, Nurses, Care Coordinators, and Administrative Staff ...
ACN Physician
Debary, FL · On-site
$210K/yr
Medical
Dental
Vision
PTO
Extensive Knowledge of Medicare Advantage Plans, HEDIS Measures, Medicare Risk Adjustment (MRA ... Collaborate with Advanced Practice Providers, Nurses, Care Coordinators, and Administrative Staff ...
ACN Physician
Debary, FL · On-site
$210K/yr
Medical
Dental
Vision
PTO
Extensive Knowledge of Medicare Advantage Plans, HEDIS Measures, Medicare Risk Adjustment (MRA ... Collaborate with Advanced Practice Providers, Nurses, Care Coordinators, and Administrative Staff ...
Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA)
Tampa, FL · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality ... Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience in ...
Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA)
Tampa, FL · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality ... Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience in ...
ACN Physician
$180K - $210K/yr
Medical
Dental
Vision
PTO
Extensive Knowledge of Medicare Advantage Plans, HEDIS Measures, Medicare Risk Adjustment (MRA ... Collaborate with Advanced Practice Providers, Nurses, Care Coordinators, and Administrative Staff ...
ACN Physician
$180K - $210K/yr
Medical
Dental
Vision
PTO
Extensive Knowledge of Medicare Advantage Plans, HEDIS Measures, Medicare Risk Adjustment (MRA ... Collaborate with Advanced Practice Providers, Nurses, Care Coordinators, and Administrative Staff ...
Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA)
Tampa, FL · Hybrid
Medical
Dental
Vision
Life
Retirement
PTO
Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality ... Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience in ...
Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA)
Tampa, FL · Hybrid
Medical
Dental
Vision
Life
Retirement
PTO
Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality ... Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience in ...
ACN Physician
$180K - $210K/yr
Medical
Dental
Vision
PTO
Extensive Knowledge of Medicare Advantage Plans, HEDIS Measures, Medicare Risk Adjustment (MRA ... Collaborate with Advanced Practice Providers, Nurses, Care Coordinators, and Administrative Staff ...
ACN Physician
$180K - $210K/yr
Medical
Dental
Vision
PTO
Extensive Knowledge of Medicare Advantage Plans, HEDIS Measures, Medicare Risk Adjustment (MRA ... Collaborate with Advanced Practice Providers, Nurses, Care Coordinators, and Administrative Staff ...
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
Nurse Navigator, MNI Office, FT, 8:00am - 4:30pm
$80K - $107K/yr
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
Nurse Navigator, MNI Office, FT, 8:00am - 4:30pm
$80K - $107K/yr
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
Director, Clinical Document Integrity | Clinical Documentation Improvement (CDI)
Gainesville, FL · On-site
$31.50 - $42.50/hr
... risk adjustment factors (HCC-RAF), in collaboration with Utilization Management and physician ... Graduate of an accredited school of nursing with current RN licensure in the State of Florida ...
Director, Clinical Document Integrity | Clinical Documentation Improvement (CDI)
Gainesville, FL · On-site
$31.50 - $42.50/hr
... risk adjustment factors (HCC-RAF), in collaboration with Utilization Management and physician ... Graduate of an accredited school of nursing with current RN licensure in the State of Florida ...
... risk adjustment factors (HCC-RAF), in collaboration with Utilization Management and physician ... Graduate of an accredited school of nursing with current RN licensure in the State of Florida ...
... risk adjustment factors (HCC-RAF), in collaboration with Utilization Management and physician ... Graduate of an accredited school of nursing with current RN licensure in the State of Florida ...
APRN -Family Medicine
Palm Coast, FL · On-site
$91K - $118K/yr
Medical
Life
Retirement
PTO
Participate in clinically driven initiatives to include annual complete physicals, quality and risk adjustment metrics Qualifications * APRN Autonomous Practitioner License * DEA License * Minimum 3 ...
APRN -Family Medicine
Palm Coast, FL · On-site
$91K - $118K/yr
Medical
Life
Retirement
PTO
Participate in clinically driven initiatives to include annual complete physicals, quality and risk adjustment metrics Qualifications * APRN Autonomous Practitioner License * DEA License * Minimum 3 ...
Nurse Navigator, Lynn Cancer Institute Multi Modality Clinic, FT, 8A-4:30P
Boca Raton, FL · On-site
$80K - $104K/yr
Medical
The Nurse Navigator is responsible for the coordination of care across the continuum, education ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
Nurse Navigator, Lynn Cancer Institute Multi Modality Clinic, FT, 8A-4:30P
Boca Raton, FL · On-site
$80K - $104K/yr
Medical
The Nurse Navigator is responsible for the coordination of care across the continuum, education ... For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
APRN -Family Medicine
$98K - $127K/yr
Medical
Life
Retirement
PTO
... and risk adjustment metrics Qualifications • APRN Autonomous Practitioner License • DEA License • Minimum 3 years' post licensing experience, working independently, in Family Medicine. • ...
APRN -Family Medicine
$98K - $127K/yr
Medical
Life
Retirement
PTO
... and risk adjustment metrics Qualifications • APRN Autonomous Practitioner License • DEA License • Minimum 3 years' post licensing experience, working independently, in Family Medicine. • ...
APRN -Family Medicine
Palm Coast, FL · On-site
$98K - $127K/yr
Medical
Life
Retirement
PTO
... and risk adjustment metrics Qualifications • APRN Autonomous Practitioner License • DEA License • Minimum 3 years' post licensing experience, working independently, in Family Medicine. • ...
APRN -Family Medicine
Palm Coast, FL · On-site
$98K - $127K/yr
Medical
Life
Retirement
PTO
... and risk adjustment metrics Qualifications • APRN Autonomous Practitioner License • DEA License • Minimum 3 years' post licensing experience, working independently, in Family Medicine. • ...
Family Nurse Practitioner Spanish Speaker
Delray Beach, FL · On-site
$103K - $131K/yr
... Risk Adjustment and HEDIS Excellent support from Physicians, Medical Assistants, and administrative staff No in-patient responsibilities Competitive salary and comprehensive benefits package ...
Family Nurse Practitioner Spanish Speaker
Delray Beach, FL · On-site
$103K - $131K/yr
... Risk Adjustment and HEDIS Excellent support from Physicians, Medical Assistants, and administrative staff No in-patient responsibilities Competitive salary and comprehensive benefits package ...
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?
| Aspect | Nurse Risk Adjustment | Nurse Case Manager |
|---|---|---|
| Certifications | RN license, risk adjustment training | RN license, case management certification |
| Work Environment | Insurance companies, healthcare analytics | Hospitals, clinics, patient homes |
| Employer & Industry | Health plans, insurance providers | Healthcare 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 Florida?
For Nurse Risk Adjustment jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Nurse Risk Adjustment jobs in Florida look for?
The top searched job categories for Nurse Risk Adjustment jobs in Florida are:
What cities in Florida are hiring for Nurse Risk Adjustment jobs?
Cities in Florida with the most Nurse Risk Adjustment job openings:
Nurse Navigator Women's Services, Lynn Women's Institute, FT, 8A-4:30P
Boca Raton, FL
$80K - $104K/yr
Full-time
Re-posted 10 days ago
Baptist Health South Florida rating
8.1
Based on 99 frontline employees who took The Breakroom Quiz
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Job description
The Nurse Navigator acts as liaison between patients, physicians and the respective care team. The Nurse Navigator is responsible for the coordination of care across the continuum, education/provision of information and support for patients, facilitation of decision making, advocacy and ultimately improved throughput and patient satisfaction. The Nurse Navigator supports the individual/significant others throughout the continuum of care in all settings. In addition, the Nurse Navigator will monitor patient outcomes, and participate in quality improvement activities. The Nurse Navigator will work in a multidisciplinary setting and collaborate with health care team members to positively impact patient outcomes and patient experiences.Estimated salary range for this position is $80516.80 - $104671.84 / year depending on experience.
Degrees:
- Associates.
Licenses & Certifications:
- Basic Life Support.
- Registered Nurse.
Additional Qualifications:
- Associate of Science degree required.
- Must have an active Registered Nurse license.
- Three years of clinical experience working in a hospital, managed care environment or medical office.
- For BHQN, knowledge of HEDIS and Star ratings, risk adjustment and HCC coding preferred.
- Proficient in computer applications and typing skills.
- Experience in Electronic Medical Record systems preferred.
- Bilingual preferred.
- Preferred certification in area of expertise.
- For Boca Regional only, BLS required.
Minimum Required Experience: 3 Years experience required. Candidates must have experience in OB, L&D or perinatal care.
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About Baptist Health South Florida
Sourced by ZipRecruiter
Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 27,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. A not-for-profit organization supported by philanthropy and committed to its faith-based charitable mission of medical excellence, Baptist Health has been recognized by Fortune as one of the 100 Best Companies to Work For in America and by Ethisphere as one of the World's Most Ethical Companies.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Miami, FL, US