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Nurse Risk Adjustment Jobs in Tennessee (NOW HIRING)

Urrly

Telehealth Nurse Practitioner

Nashville, TN · Remote

$600 - $720/day

Telehealth Nurse Practitioner * Location/Type: Tennessee Remote (No travel) * Pay: $600-$720/day ... Document risk adjustment (HCC coding) during patient visits * Close HEDIS care gaps during visits

Altegra Health

Remote Certified Coders

Memphis, TN · Remote

$21.75 - $29.75/hr

... nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical ...

Altegra Health

Remote Certified Coders

Memphis, TN · On-site +1

$21.75 - $29.75/hr

... nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical ...

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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 Tennessee? For Nurse Risk Adjustment jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Nurse Risk Adjustment jobs in Tennessee look for? The top searched job categories for Nurse Risk Adjustment jobs in Tennessee are:
What cities in Tennessee are hiring for Nurse Risk Adjustment jobs? Cities in Tennessee with the most Nurse Risk Adjustment job openings:
Nurse Risk Adjustment jobs near you
Infographic showing various Nurse Risk Adjustment job openings in Tennessee 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.

Manager-Clinical Documentation Senior

Baptist Memorial Health Care Corporation

Memphis, TN • On-site

Full-time

Re-posted 29 days ago

Baptist Memorial Health Care rating

7.3

Company rating: 7.3 out of 10

Based on 113 frontline employees who took The Breakroom Quiz

304th of 887 rated healthcare providers

Job description

Overview
Clinical Documentation Manager
Summary:
The Clinical Documentation Manager assists in the development of operational framework focused on scalable and repeatable best practices as it relates to Risk Adjustment. This position supports and aligns planning to ensure the key strategic activities aimed at HCC/RAF management for Value-Based Care is delivered and executed at the clinic level. Expert in reviewing, assigning and validating ICD-10-CM codes for diagnoses performed by physicians and other qualified healthcare providers. Ensures diagnostic coding accuracy and compliance for each Plan's member. The Clinical Documentation Manager will coordinate work in clinics to provide support and education to all market leaders, Providers and clinic staff. This position identifies, develops and implements simplification and automation to improve HCC/RAF initiatives. The Clinical Documentation Manager will also act as a facilitator, leader, mentor and change agent. Travel is required throughout the region.
Duties:
  • Review clinical documentation and assign accurate diagnosis codes according to guidelines and project
  • Review medical documents such as surgical reports, medical visits, and diagnostic reports in order to create educational strategies to ensure correct diagnosis code assignment by the provider.
  • Perform Clinical Chart Audits for proper HCC documentation on an ongoing basis.
  • Extracts data from practice EMR or network database to identify HCC documentation and care gap opportunities to assess positive and negative changes in quality scores month over month.
  • Reviews registries with PCPs and/or key office staff to identify care gaps and opportunities for outreach, HCC documentation and/or care gap closure.
  • Be able to identify opportunities in diagnosis coding, clinical documentation and billing within the provider's day-to-day operations.
  • Collaborate with and support primary care providers and practice support staff to improve population health performance and achieve quality incentives related to managed care contracts by managing and organizing data, engaging patients, and optimizing workflow, with the goal of optimizing our patients' health and wellbeing.
  • Facilitates and assists with outreach to patients via phone calls, mail or electronic messaging, to schedule appointments, screenings, and preventive tests.
  • Educate practitioners/clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process.
  • Maintains a log of audits and education performed of diagnosis/HCC gaps.
  • Prepares and submits a monthly report of activities performed during payer meetings.

Core Competencies:
  • Understands the CMS-HCC (Hierarchical Condition Category) Risk Adjustment Model and ICD-9/10 guidelines.
  • Extensive background in supporting risk adjustment management activities and clinical informatics
  • Experience with Risk Adjustment Data Validation
  • Demonstrate the ability to teach and evaluate clinical staff as it relates to HCC/RAF management at the clinic level.
  • Maintain compliance with AAPC coding standards and CMS Risk Adjustment guidelines.
  • Remains current on CMS rules and guidelines.

Minimum Required Preferred / Desired Experience
5 years of general healthcare experience
3 years of clinical coding experience with strong attention to detail and a high level of accuracy.
Education Registered Nurse and/or AAPC Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) Bachelor's Degree in Nursing (8 or more years of additional experience beyond the required years of experience may be substituted in lieu of a bachelor's degree. Training Certified Risk Adjustment Coder (CRC) certification or proof that certification has been obtained within 6 months of start date from the American Academy of Professional Coders. Special Skills MS Office Suite, moderate to advanced EXCEL and PowerPoint skills. Knowledge of audiovisual equipment set up. Licensure AAPC Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) or if current RN license in good standing, must be a Certified Risk Adjustment Coder (CRC)
Ability to work a flexible work schedule and travel to all assigned BMG clinics.

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About Baptist Memorial

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Baptist Memorial, based in Memphis, TN, US, is a leading health care organization renowned in the healthcare industry. The company's official website is baptistonline.org which provides a comprehensive view of their services and operations. Baptist Memorial operates a myriad of hospitals, health clinics, and medical facilities providing expert and compassionate care. Founded in 1912, it has a rich legacy of over a hundred years of dedication to its community, offering services which include acute care, diagnostic services, and a broad range of speciality health services fulfilling various patient needs.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Memphis, TN, US

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