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Nurse Risk Adjustment Jobs in Georgia (NOW HIRING)

CVS Health

Senior Medical Director

Riverdale, GA · On-site

... Risk Adjustment Clinical Compliance & Policy Development This includes representing Oak Street to ... Supervising the Transitions Nurses, who track all hospitalized patients and coordinate post ...

Western NSW Local Health District

$41.23 - $57.88/hr

Western NSW LHD can provide reasonable adjustments in the workplace. Applicants who provide ... Risk Management Unit (RMU). This review will consider the applicant's needs and what reasonable ...

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Nurse Risk Adjustment information

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 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 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 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.
What are popular job titles related to Nurse Risk Adjustment jobs in Georgia? For Nurse Risk Adjustment jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Nurse Risk Adjustment jobs in Georgia look for? The top searched job categories for Nurse Risk Adjustment jobs in Georgia are:
What cities in Georgia are hiring for Nurse Risk Adjustment jobs? Cities in Georgia with the most Nurse Risk Adjustment job openings:
Nurse Risk Adjustment jobs near you
Infographic showing various Nurse Risk Adjustment job openings in Georgia as of August 2026, with employment types broken down into 81% Full Time, 12% Part Time, and 7% Contract. Highlights an 92% In-person, and 8% Remote job distribution.

Upperline Health Plus Nurse Practitioner Opportunity Stockbridge GA | Value-Based Care

Upperline Health

Stockbridge, GA • On-site

$87K - $119K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 24 days ago

Upperline Health rating

3.5

Company rating: 3.5 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

Job description

10k Sign-On Bonus
A Specialty Path to Good Health
Upperline Health is the nation's largest provider group dedicated to lower extremity, wound and vascular care. Founded in 2017 with the ambitious goal of transforming specialty care, Upperline Health is a pioneer in bringing value-based care models into specialty care. Upperline delivers a more efficient path for patients to receive consistent and effective treatment for chronic illnesses.
Triage is temporary.
Treatment is transformative.
Upperline Health providers coordinate patients' care among a team of specialists - physicians, advanced practice providers, care navigators, pharmacists, dieticians, and social workers for integrated treatment that addresses patients' immediate and long-term health needs.
We put patients at the center of value-based care.
Why join our team?
  • Highly competitive salary plus annual bonus opportunity
  • Generous benefit options include comprehensive medical, dental & vision, 401K, PTO and parental leave
  • Continuing Medical Education reimbursement
  • State license reimbursement
  • Highly supportive interdisciplinary team
  • Work Life Balance - regular weekday schedule
  • Rapidly growing company with potential leadership & career growth opportunities
About the Nurse Practitioner (APP) PositionUpperline Health is seeking a Nurse Practitioner to provide clinic-based care in our Stockbridge, GA Clinic. In collaboration with Upperline's local Physician team, APPs develop complex plans of care in accordance with the patient's health status and overall goals and values; provide medical diagnostics and treatments in the clinic, in the patient's home, or via telehealth, consistent with the APP's scope of practice and the patient's medical condition; educate patients and families on medication usage, diet & nutrition, and crisis anticipation & prevention. They will also communicate medical information to patients' physicians, other providers and Upperline's Physician team and broader interdisciplinary team.
Ideal candidates will have experience with the following: Primary Care/Internal Medicine, geriatric care and/or home-based care, Palliative or Hospice care and/or previously worked in a value-based care environment. Most importantly, candidates must demonstrate compassion for patient needs, have great attention to detail, and thrive in a collaborative environment with rapid growth.
This is a unique opportunity to make a meaningful impact and meet the needs of at-risk patients in both primary and specialty care, with a regular weekday schedule!
What You'll Do:
  • Develop and implement clinical plans of care for adult patients facing chronic conditions (e.g., diabetes, COPD, CHF, debility, dementia).
  • Gather patient history, physical exam, and diagnostics within a clinic setting, via telehealth, or within the patient's home.
  • Develop and implement treatment plans given patient's goals of care and current conditions.
  • Collaborate with the interdisciplinary team to meet the patient and family's physical as well as psychosocial needs.
  • .Provide compassionate care for our complex patients and their families
  • Educate patients and families about medication usage, side effects, illness progression, diet & nutrition, medical adherence and crisis anticipation & prevention.
  • Communicate with other Upperline clinical team members as well as patient's community providers, to coordinate optimal care and resources for the patient and their family.
  • Communicate with Upperline's local physician to review patient records and care plans on a timely basis consistent with state regulations and company standards and policy.
  • Maintain patient medical records and medical documentation consistent with state regulations and company standards and policy.
  • Complete accurate and timely documentation according to risk adjustment standards per education provided.
  • Take part in weekly interdisciplinary team meetings and scheduled education sessions.
  • Provide telephonic support for escalated calls from triage nurse.
  • Participate in continuing education as required by the state Board of Nursing.
  • Prescribe medication as permitted by the state Board of Nursing.
  • Other related duties as deemed necessary.
Required Skills, Education, and Competencies:
  • Master's degree in nursing required
  • Board Certification as an Adult, Adult-Geriatric or Family Nurse Practitioner required
  • Current State Registered Nurse & Nurse Practitioner license required
  • Basic Life Support (BLS) certification is required
  • 6 Months nurse practitioner experience in Primary Care/Internal Medicine
  • Value-based care experience preferred
  • Possession of DEA registration or eligibility
  • Must be comfortable providing care in patients homes
  • Previous experience managing, supervising, or coaching clinicians highly preferred
  • A reliable automobile, valid driver's license and minimum state required liability auto insurance are required; Mileage reimbursement provided
  • Adaptability to thrive is a fast-paced growth-forward environment
  • Experience working in an EMR - AthenaHealth EMR is highly preferred
  • Proficiency using Microsoft Office products
  • Excellent oral and written communication skills to ensure that each of your interactions with patients, family caregivers, clinicians, and team members is effective and meaningful.

Compensation
Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience
Job Type: Full-time
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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