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Remote Nurse Risk Management Jobs in Minnesota (NOW HIRING)

Deloitte

Consultant - ServiceNow

Minneapolis, MN · Remote

... manage cyber, risk, and technology programs. Recruiting for this role ends on 12/31/2026. Work you ... This compensation range is specific to a Remote role and takes into account the wide range of ...

illumifin

Claims Manager - LSW or RN

Eden Prairie, MN · On-site +1

$60K/yr

We also provide clients with unique risk management insight built upon our proprietary long term ... Current and Unrestricted Registered Nurse (RN) or Social Work license. * Four-year college degree ...

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Remote Nurse Risk Management information

What is the difference between Remote Nurse Risk Management vs Remote Nurse Compliance Coordinator?

AspectRemote Nurse Risk ManagementRemote Nurse Compliance Coordinator
CertificationsRN license, risk management certifications (e.g., CPHRM)RN license, compliance certifications (e.g., CHC, CCEP)
Work EnvironmentHealthcare facilities, insurance companies, legal teamsHealthcare organizations, regulatory agencies, legal departments
Employer UsageFocus on patient safety, legal risk reductionFocus on regulatory adherence, policy implementation

Remote Nurse Risk Management and Remote Nurse Compliance Coordinator roles share similar credentials and work environments but differ in focus. Risk managers primarily handle patient safety and legal risk, while compliance coordinators ensure adherence to healthcare regulations and policies. Both roles are vital in healthcare settings and often overlap in responsibilities, but their core objectives distinguish them clearly.

What are remote nurse risk managers?

Remote nurse risk managers are registered nurses who work offsite, using digital tools and telecommunication to assess, monitor, and mitigate risks in healthcare settings. They review patient care processes, analyze incident reports, and collaborate with healthcare teams to ensure patient safety and regulatory compliance. By working remotely, they help identify potential risks and implement strategies to reduce errors, improve quality of care, and prevent legal or financial liabilities for healthcare organizations.

What are the key skills and qualifications needed to thrive as a Remote Nurse Risk Management professional, and why are they important?

To thrive as a Remote Nurse Risk Management professional, you need a strong background in clinical nursing, risk assessment, and healthcare compliance, usually supported by an active RN license and experience in risk management. Familiarity with incident reporting systems, risk analysis software, and electronic health records (EHRs) is often required, along with certifications such as CPHRM (Certified Professional in Healthcare Risk Management). Strong analytical thinking, attention to detail, and effective communication are essential soft skills for evaluating risks and collaborating with cross-functional teams. These skills are crucial to proactively identify and mitigate patient safety risks, ensure regulatory compliance, and promote quality care in a remote setting.

How does a remote nurse in risk management typically collaborate with other healthcare professionals while working offsite?

Remote nurse risk managers regularly collaborate with physicians, case managers, and administrative staff through secure digital platforms such as video conferencing, electronic health records, and messaging systems. They often participate in virtual meetings to discuss patient safety concerns, review incident reports, and help develop protocols to mitigate risk. Effective communication and organization are essential, as remote collaboration requires proactive follow-up and clear documentation to ensure all stakeholders are aligned on risk management strategies.
What are popular job titles related to Remote Nurse Risk Management jobs in Minnesota? For Remote Nurse Risk Management jobs in Minnesota, the most frequently searched job titles are:
What job categories do people searching Remote Nurse Risk Management jobs in Minnesota look for? The top searched job categories for Remote Nurse Risk Management jobs in Minnesota are:
What cities in Minnesota are hiring for Remote Nurse Risk Management jobs? Cities in Minnesota with the most Remote Nurse Risk Management job openings:
Remote Nurse Risk Management jobs near you
Informatics Risk Adjustment Consultant

Informatics Risk Adjustment Consultant

HealthPartners

Saint Paul, MN • On-site, Remote

$63.77 - $95.65/hr

Full-time

Medical, Retirement

Re-posted 5 days ago

HealthPartners rating

7.7

Company rating: 7.7 out of 10

Based on 132 frontline employees who took The Breakroom Quiz

157th of 884 rated healthcare providers

Job description


HealthPartners is hiring a Informatics Risk Adjustment Consultant. The Informatics Consultant -supports the Health Plan's risk adjustment operations by delivering trusted, prioritized, and compliant data insights that drive efficient workflows and improve risk score accuracy, while continuously refining processes through feedback. This role ensures the plan's risk adjustment outputs are accurately represented in claims and encounter data, analytics, and reporting.
The consultant serves as a bridge between the data/technology teams and risk adjustment operations, clinical/provider stakeholders, coding and chart review teams, and compliance/audit partners. The role enables informed, compliant, and actionable risk adjustment program, while maintaining strong governance, audit readiness, and organizational standards.
ACCOUNTABILITIES:
Risk Adjustment Strategy & Program Execution
  • Support planning and execution of annual risk adjustment initiatives (prospective, concurrent, and retrospective), aligned to plan goals and regulatory requirements.
  • Translate risk adjustment priorities into practical workflows, playbooks, and measurable interventions across provider groups and vendor partners.
  • Partner with risk adjustment operations to optimize data capture, risk score modeling, member stratifications, suspecting logic, and program outcomes.

Diagnosis Accuracy, Clinical Validity & Documentation Integrity
  • Identify patterns of under-capture, over-capture, and potential diagnosis coding inaccuracies; drive suspecting logic and workflow improvements.
  • Support provider-facing reporting

Encounter & Claims Data Quality (Core Health Plan Focus)
  • Work with operational and technical teams to improve completeness, timeliness, and accuracy of encounter data and diagnosis submission (including resolving rejections, edit failures, and submission gaps).
  • Define and monitor data quality KPIs (e.g., encounter internal validations, submission rates, acceptance rates, diagnosis completeness, provider group variation, lag time).

Provider & Vendor Enablement (External-Facing Consulting)
  • Support relationships with provider groups, delegated entities, and vendor partners to improve data exchange and workflows
  • Participate in vendor management activities (requirements gathering, performance monitoring, issue escalation, and continuous improvement).

Measurement, Analytics & Performance Reporting
  • Define and track risk adjustment performance measures such as:
    • Reconfirmation rates and suspected-condition confirmation rates
    • Member visit rates and provider engagement
    • Condition prevalence shifts and variation analysis
    • Net risk score movement (where appropriate) with integrity guardrails, and drivers of risk
    • Encounter submission acceptance rates
    • Audit results and feedback loop reporting
  • Partner with analytics teams to develop dashboards and actionable reporting (e.g., Power BI), and to ensure consistent measure definitions.

Compliance, Audit Readiness & Governance
  • Partner with compliance, internal audit, and risk adjustment leadership to support audit readiness (e.g., documentation standards, monitoring, validation processes).
  • Help implement controls and monitoring to identify outliers and reduce risk (e.g., unusual provider patterns, unsupported diagnoses, excessive suspecting false positives).
  • Maintain familiarity with current risk adjustment policies and guidance, and support operational implementation of updates.

Cross-Functional Leadership & Change Management
  • Facilitate collaboration between data/technology teams and risk adjustment operations, clinical/provider stakeholders, coding and chart review teams, and compliance/audit partners.
  • When asked, co-lead small to medium initiatives end-to-end, including requirements definition, workflow design, stakeholder engagement, training, measurement, and sustainment.
    REQUIRED QUALIFICATIONS:

1. Education
  • Bachelor's degree in health informatics, nursing, health information management, public health, business, or related field; or equivalent combination of education and experience.

2. Experience and Knowledge
  • 5+ years of experience in health plan and/or risk adjustment-related domains, such as: risk adjustment operations, encounter data management, coding, clinical documentation integrity, provider performance, quality improvement, or healthcare analytics.
  • Working knowledge of how diagnoses flow through EHR → coding/chart review → encounter/claims submission → risk adjustment analytics.
  • Experience collaborating with provider organizations and/or delegated entities to improve documentation and data submission practices.
  • Experience using data to drive improvement: ability to interpret trends, variation, root cause issues, and performance metrics.
  • Familiarity with Medicare Advantage (preferred) and/or other risk programs, including chart review concepts and audit sensitivity.

3. Skills
  • Strong consulting, facilitation, and stakeholder management skills; able to influence without authority.
  • Excellent written and verbal communication; able to create clear playbooks, training, and executive-ready summaries.
  • Strong analytical thinking and operational problem-solving; comfortable navigating ambiguous issues across workflows and systems.
  • High integrity and sound judgment; commitment to compliant, clinically appropriate documentation practices.
  • Strong project management skills; ability to manage multiple workstreams, deadlines, and cross-functional dependencies.

PREFERRED QUALIFICATIONS:
  • Credentials such as CRC, CPC, CCS, CDIP, CCDS (or comparable).
  • Experience working directly with MA encounter submission processes, edit resolution, or encounter data ingestion/validation.
  • Experience supporting chart retrieval/coding vendors and performance management (KPIs, SLAs, escalation paths).
  • Familiarity with audit processes and documentation standards (e.g., retrospective validation, risk adjustment audits), and designing monitoring/controls.
  • Experience developing or specifying requirements for dashboards and operational reporting (Power BI, Tableau, or equivalent).
  • Solid working experience with SQL and relational database design
  • Exposure to agile/scrum
  • Experience using Azure suite of tools, Databricks, Azure Data Lake
  • Experience in a highly regulated environment and comfort partnering closely with compliance and privacy.

About Us
At HealthPartners we believe in the power of good - good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Benefits Designed to Support Your Total HealthAs a HealthPartners colleague, we're committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.
Join us in our mission to improve the health and well-being of our patients, members, and communities.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.

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