Woonsocket, RI · On-site
$75K - $165K/yr
Health Information Management (RHIA/RHIT) * Nursing - Strong understanding of clinical documentation and medical record review * Certified Risk Adjustment Coder (CRC) with compliance experience
Woonsocket, RI · On-site
$75K - $165K/yr
Health Information Management (RHIA/RHIT) * Nursing - Strong understanding of clinical documentation and medical record review * Certified Risk Adjustment Coder (CRC) with compliance experience
Providence, RI · On-site
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Providence, RI · On-site
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Providence, RI · On-site
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Providence, RI · On-site
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Providence, RI · On-site
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Providence, RI · On-site
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Providence, RI · On-site
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Providence, RI · On-site
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Providence, RI · On-site
$27.50 - $37.50/hr
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Providence, RI · On-site
$27.50 - $37.50/hr
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Providence, RI · On-site
$27.50 - $37.50/hr
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Providence, RI · On-site
$27.50 - $37.50/hr
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
$31.25 - $40/hr
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
$31.25 - $40/hr
Identify, assess and respond to crisis situations, providing appropriate risk management and crisis ... Nursing. * Experience working with psychiatric/mental health patients and substance use treatment ...
Warwick, RI · On-site
Job Summary The Nurse Manager oversees daily operations, patient flow, and clinical care in the ... Expertise in quality improvement, risk management, patient safety practices, and just-culture ...
Warwick, RI · On-site
Job Summary The Nurse Manager oversees daily operations, patient flow, and clinical care in the ... Expertise in quality improvement, risk management, patient safety practices, and just-culture ...
Providence, RI · On-site
Nursing Services * Assess immediate and long-term physical, mental and social health care needs of ... D. Quality Improvement/Risk Management * Maintain and review records and reports essential to ...
Quick apply
Providence, RI · On-site
Nursing Services * Assess immediate and long-term physical, mental and social health care needs of ... D. Quality Improvement/Risk Management * Maintain and review records and reports essential to ...
Job Summary The Nurse Manager oversees daily operations, patient flow, and clinical care in the ... Expertise in quality improvement, risk management, patient safety practices, and just-culture ...
Job Summary The Nurse Manager oversees daily operations, patient flow, and clinical care in the ... Expertise in quality improvement, risk management, patient safety practices, and just-culture ...
Providence, RI · On-site
$35.70 - $71.40/hr
Engage in quality improvement initiatives and risk management activities, attending relevant ... Provide guidance and direction to LPNs, CNAs, and other licensed personnel as needed. * May take on ...
Quick apply
Providence, RI · On-site
$35.70 - $71.40/hr
Engage in quality improvement initiatives and risk management activities, attending relevant ... Provide guidance and direction to LPNs, CNAs, and other licensed personnel as needed. * May take on ...
$35.70 - $71.40/hr
Participates in quality improvement processes and risk management activities. Attends unit-based ... Integrates complete physical assessment with nursing assessment, and records reviews in developing ...
$35.70 - $71.40/hr
Participates in quality improvement processes and risk management activities. Attends unit-based ... Integrates complete physical assessment with nursing assessment, and records reviews in developing ...
Newport, RI · On-site
$35.70 - $71.40/hr
Participates in quality improvement processes and risk management activities. Attends unit-based ... Integrates complete physical assessment with nursing assessment, and records reviews in developing ...
Newport, RI · On-site
$35.70 - $71.40/hr
Participates in quality improvement processes and risk management activities. Attends unit-based ... Integrates complete physical assessment with nursing assessment, and records reviews in developing ...
Newport, RI · On-site
$35.70 - $71.40/hr
Participates in quality improvement processes and risk management activities. Attend unit-based or ... Integrates complete physical assessment with nursing assessment, and records reviews in developing ...
Newport, RI · On-site
$35.70 - $71.40/hr
Participates in quality improvement processes and risk management activities. Attend unit-based or ... Integrates complete physical assessment with nursing assessment, and records reviews in developing ...
$50.4K - $61K
4% of jobs
$61K - $71.5K
6% of jobs
$71.5K - $82.1K
11% of jobs
$86K is the 25th percentile. Wages below this are outliers.
$82.1K - $92.6K
11% of jobs
The median wage is $101K / yr.
$92.6K - $103.2K
23% of jobs
$103.2K - $113.7K
13% of jobs
$120.7K is the 75th percentile. Wages above this are outliers.
$113.7K - $124.3K
12% of jobs
$124.3K - $134.8K
8% of jobs
$134.8K - $145.4K
6% of jobs
$145.4K - $155.9K
4% of jobs
$155.9K - $166.5K
2% of jobs
$50.4K
$109.2K
$166.5K
As a Nurse Risk Management professional, your daily tasks often include reviewing and investigating incident reports, analyzing trends to identify potential risks, and collaborating with clinical teams to implement preventative strategies. You may conduct staff training on safety protocols, participate in policy development, and ensure compliance with healthcare regulations. Regular meetings with cross-functional teams, such as quality assurance and legal departments, are common to address ongoing risk issues. This variety of responsibilities provides an engaging environment where you play a key role in enhancing patient safety and organizational effectiveness.
To thrive as a Nurse Risk Management professional, you need a strong clinical nursing background, analytical skills, and a relevant nursing license, often supplemented by experience in risk management or patient safety. Familiarity with incident reporting systems, root cause analysis tools, and certifications such as Certified Professional in Healthcare Risk Management (CPHRM) are highly valued. Outstanding communication, problem-solving, and attention to detail are critical soft skills that help manage complex situations and foster effective collaboration. These competencies are vital to proactively identifying and mitigating risks, ensuring regulatory compliance, and improving patient outcomes in healthcare organizations.
A Nurse Risk Management job involves identifying, assessing, and mitigating risks within healthcare settings to ensure patient safety and regulatory compliance. These nurses analyze incidents, develop policies to reduce liability, and collaborate with healthcare teams to improve safety protocols. They also educate staff on best practices to minimize errors and enhance care quality. Their role helps prevent legal issues and promotes a culture of safety in healthcare organizations.
$75K - $165K/yr
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 11 days ago
5.8
Based on 4,326 frontline employees who took The Breakroom Quiz
88th of 110 rated pharmacies
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
Position Summary
As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk Adjustment, Hierarchical Condition Categories (HCCs), encounter data submission, documentation and coding compliance, and related regulatory requirements. This position serves as a key compliance leader and subject matter expert, partnering with Risk Adjustment Operations, Coding, Provider Education, Clinical Documentation Improvement (CDI), Internal Audit, Legal, and Government Affairs teams to ensure organizational adherence to CMS requirements.
The ideal candidate possesses extensive experience in Medicare Advantage compliance and a deep understanding of CMS Risk Adjustment methodologies, diagnosis coding requirements, medical record documentation standards, RADV audits, and evolving regulatory guidance.
Key Responsibilities
Lead the Medicare Advantage Risk Adjustment compliance program.
Monitor and interpret CMS regulations, HPMS memoranda, Final Rules, Medicare Managed Care Manual guidance, RADV requirements, and OIG enforcement activities.
Assess operational processes for compliance risks related to risk adjustment activities.
Develop and implement corrective action plans for identified compliance issues.
Conduct compliance risk assessments related to coding, documentation, and encounter data submissions.
Required Qualifications
Minimum 7 years of experience in Medicare Advantage, Risk Adjustment, Coding Compliance, Audit, or Regulatory Compliance
Minimum 5 years in a leadership role
One or more of the following certifications: CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist)
Willingness to travel up to 10% (including by plane)
Preferred Qualifications
Health Information Management (RHIA/RHIT)
Nursing - Strong understanding of clinical documentation and medical record review
Certified Risk Adjustment Coder (CRC) with compliance experience
Provider coding audit/compliance leadership experience
Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits
Education
Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Compliance, or a related healthcare field required; equivalent years of work experience may substitue.
Pay Range
The typical pay range for this role is:
$75,400.00 - $165,954.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Health care and social assistance and retail
10,000+ Employees
Woonsocket, RI, US
