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Remote Medicare Risk Adjustment Jobs in Virginia

Corvel

Claims Specialist

Glen Allen, VA · Remote

$52K - $85K/yr

This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Receives Workers' Compensation ... The level may impact the salary range and these adjustments would be clarified during the offer ...

Corvel

Medical Only Claims Specialist

Glen Allen, VA · Remote

$16.74 - $26.92/hr

This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Receives Workers' Compensation ... The level may impact the salary range and these adjustments would be clarified during the offer ...

Corvel

Claims Specialist

Glen Allen, VA · Remote

$52K - $85K/yr

This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Receives auto and general ... The level may impact the salary range and these adjustments would be clarified during the offer ...

Corvel

Telehealth Coordinator Lead

Glen Allen, VA · On-site +1

$19.24 - $31.04/hr

This is a remote role but requires residency in Arizona or Virginia. The work schedule for this ... The level may impact the salary range and these adjustments would be clarified during the offer ...

Corvel

Account Executive II

Fairfax, VA · Remote

$70K - $116K/yr

This is a remote role. Candidate must live in the Virginia or Washington, D.C Territory. ESSENTIAL ... The level may impact the salary range and these adjustments would be clarified during the offer ...

Corvel

Telehealth Coordinator Lead

Glen Allen, VA · Remote

$19.24 - $31.04/hr

This is a remote role but requires residency in Arizona or Virginia. The work schedule for this ... The level may impact the salary range and these adjustments would be clarified during the offer ...

World Wide Technology

$130K - $135K/yr

The ability to balance security principles with business realities as part of a risk-managed ... LI-MP1 LI-REMOTE

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Showing results 21-40

All JobsMedicare Risk Adjustment JobsRemote Medicare Risk Adjustment JobsRemote Medicare Risk Adjustment Jobs in Virginia

Remote Medicare Risk Adjustment information

What is the difference between Remote Medicare Risk Adjustment vs Remote Medical Coding Specialist?

AspectRemote Medicare Risk AdjustmentRemote Medical Coding Specialist
CertificationsCPR, CPC, or RAC certifications often preferredCPC, CCS, or CCS-P certifications
Work EnvironmentHealthcare insurance companies, Medicare plansHospitals, clinics, insurance companies
Industry UsagePrimarily in Medicare risk adjustment programsMedical billing and coding across various healthcare settings

Remote Medicare Risk Adjustment and Remote Medical Coding Specialist roles share certifications and healthcare industry usage but differ in focus. Medicare Risk Adjustment involves analyzing patient data to optimize Medicare plan reimbursements, while Medical Coding Specialists translate medical records into billing codes. Both roles require healthcare knowledge but serve distinct functions within the healthcare revenue cycle.

What are the most commonly searched types of Medicare Risk Adjustment jobs in Virginia? The most popular types of Medicare Risk Adjustment jobs in Virginia are:
What are popular job titles related to Remote Medicare Risk Adjustment jobs in Virginia? For Remote Medicare Risk Adjustment jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Remote Medicare Risk Adjustment jobs in Virginia look for? The top searched job categories for Remote Medicare Risk Adjustment jobs in Virginia are:
What cities in Virginia are hiring for Remote Medicare Risk Adjustment jobs? Cities in Virginia with the most Remote Medicare Risk Adjustment job openings:
Remote Medicare Risk Adjustment jobs near you
Infographic showing various Remote Medicare Risk Adjustment job openings in Virginia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Integrated Nurse Case Manager/RN for Maternal Health/ Perinatal for Central Richmond (Henrico, Hanov

Sentara Healthcare

Colonial Heights, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 398 frontline employees who took The Breakroom Quiz

492nd of 887 rated healthcare providers

Job description

City/State
Richmond, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN for Maternal Health/ Perinatal for Central Richmond (Henrico, Hanover, Colonial Heights, VA) and the surrounding areas!
The position requires both telephonic and face-to-face assessments and remote telephonic assessments for the low-risk and high-risk pregnant population (Maternal Health / Perinatal / OB-GYN /Labor and Delivery / Mother-Baby / Postpartum) in Central Richmond (Henrico, Hanover, Colonial Heights, VA) and the surrounding areas.
Status: Full-time, permanent position (40 hours)
Standard working hours: 8am to 5pm EST, M-F
Location: Applicants must reside in Central Richmond (Henrico, Hanover, Colonial Heights, VA) and the surrounding areas.
Primary responsibilities include:
  • Responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum
  • Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination, and management of members' needs, including physical and behavioral health, social services and long-term services
  • Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team
  • Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost-effective and efficient utilization of health benefits; conducts gap in care management for quality programs
  • Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible
  • Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans
  • Presents cases at case conferences for multidisciplinary focus. Ensures compliance with regulatory, accrediting and company policies and procedures
  • May assist in problem solving with provider, claims or service issues.

Education:
  • Associate or Bachelors Degree in Nursing REQUIRED

Certification/Licensure:
  • Registered Nurse (RN) License (Compact or Virginia) REQUIRED

Experience:
  • 3 years experience in Nursing REQUIRED
  • Case Management experience preferred
  • Managed Care or Health Plan or Medicaid experience preferred
  • Experience working with low and high risk pregnant population (Maternal Health / Perinatal / OB-GYN /Labor and Delivery / Mother-Baby / Postpartum) experience preferred
  • Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs.
  • Excellent communication skills, both oral and written, as well as strong problem-solving and analytical skills

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services-all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-103452
#Indeed
Talroo - Nursing
Care Coordination, Case Management, RN, Case Manager, Registered Nurse, BSN, ADN, Nursing, Managed Care, MCO, Health Plan, high-risk pregnant members, Maternity, OBGYN, Labor and Delivery, Mother and Baby, Postpartum, L&D, Central Richmond, Henrico, Hanover, Colonial Heights, VA, Medicaid
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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