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Rn Risk Manager Jobs in Worcester, MA (NOW HIRING)

BrightStar Care

Registered Nurse Case Manager

Waltham, MA · On-site

$50 - $60/hr

Registered Nurse Case Manager Join our Rockstar Team of Registered Nurses (RN) with BrightStar Care ... Quality Assurance & Risk Management: Experience in auditing, incident reporting, and maintaining ...

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Rn Risk Manager information

See Worcester, MA salary details

$51.4K

$111.3K

$169.6K

How much do rn risk manager jobs pay per year?

As of Sep 11, 2026, the average yearly pay for rn risk manager in Worcester, MA is $111,313.00, according to ZipRecruiter salary data. Most workers in this role earn between $89,800.00 and $128,700.00 per year, depending on experience, location, and employer.

What is an RN Risk manager?

An RN Risk Manager is a registered nurse who specializes in identifying, evaluating, and minimizing risks to patients, staff, and healthcare organizations. They work to prevent medical errors, manage incident reports, and ensure compliance with safety regulations and accreditation standards. RN Risk Managers often collaborate with healthcare teams to create safer environments and develop policies that improve patient outcomes. They also play a vital role in investigating adverse events and recommending corrective actions to reduce future risks.

What are the key skills and qualifications needed to thrive as an RN Risk manager?

To thrive as an RN Risk Manager, you need a solid background in nursing practice, risk assessment, and healthcare regulations, generally supported by an active RN license and experience in clinical or quality management. Familiarity with risk management software, incident reporting systems, and certifications like Certified Professional in Healthcare Risk Management (CPHRM) are highly beneficial. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for proactively identifying and addressing potential risks. These skills and qualities are vital to ensure patient safety, regulatory compliance, and the mitigation of organizational liabilities in healthcare settings.

What are some common challenges faced by RN Risk managers, and how can they effectively navigate them?

RN Risk Managers often face challenges such as balancing regulatory compliance with practical patient care, staying updated on evolving healthcare laws, and facilitating open communication among clinical staff. Navigating these challenges requires strong analytical skills, ongoing education in risk management policies, and the ability to foster a culture of safety. Building collaborative relationships across departments and proactively identifying potential risks can also help RN Risk Managers address issues before they escalate.

What is the difference between Rn Risk Manager vs Rn Safety Coordinator?

AspectRn Risk ManagerRn Safety Coordinator
CertificationsRN license, OSHA, risk management certificationsRN license, OSHA, safety certifications
Work EnvironmentHealthcare facilities, hospitals, clinicsHealthcare settings, clinics, outpatient facilities
Primary FocusIdentifying and mitigating risks, compliance, policy developmentImplementing safety protocols, staff training, incident prevention

The Rn Risk Manager focuses on assessing and managing risks within healthcare organizations, ensuring compliance and reducing liability. The Rn Safety Coordinator concentrates on implementing safety procedures and training staff to prevent accidents. While both roles require RN licensure and safety certifications, their core responsibilities differ in scope and focus, with the Risk Manager handling broader risk strategies and the Safety Coordinator emphasizing safety implementation.

What does a registered nurse risk manager do?

A registered nurse risk manager oversees patient safety and quality improvement initiatives within healthcare facilities. They analyze clinical data, develop risk mitigation strategies, and ensure compliance with healthcare regulations, often using tools like incident reporting systems. Certification in risk management or nursing is typically required for this role.

What cities near Worcester, MA are hiring for Rn Risk Manager jobs?

Cities near Worcester, MA with the most Rn Risk Manager job openings:

Rn Risk Manager jobs near you
Infographic showing various Rn Risk Manager job openings in Worcester, MA as of August 2026, with employment types broken down into 84% Full Time, 13% Part Time, and 3% Contract. Highlights an 84% Physical, 2% Hybrid, and 14% Remote job distribution, with an average salary of $111,313 per year, or $53.5 per hour.

Manager, Risk Adjustment

Worcester, MA

Mass Advantage
Health Care and Social Assistance • 51 - 200 employees
Learn more about Mass Advantageexternal

Full-time

Re-posted 28 days ago

Key responsibilities

  • Oversee the strategy, execution, and performance of Medicare risk adjustment programs, including prospective and retrospective activities.

  • Lead RADV audit readiness, response, and compliance activities, including medical record retrieval and validation.

  • Build and maintain analytics dashboards, KPIs, and reporting to monitor risk score accuracy, coding yield, and program ROI.

Job description

Description

Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester County, headquartered in Worcester MA. Mass Advantage is owned and designed by UMass Memorial Health providers with their patients' needs in mind.


We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for the strategy, execution and performance of Medicare risk adjustment programs, infrastructure and systems to meet business objectives, revenue expectations, management of external vendors, interaction with Providers, regulatory audits, and compliance with CMS regulations. The Manager of Risk Management is also responsible for analysis, projections, and assessment of Medicare revenue initiatives for senior products; leading and coordinating enterprise risk adjustment initiatives, working with the necessary areas of Mass Advantage and UMass Memorial Health Operations as well as vendor partners.


Essential Duties and Responsibilities:

Program Strategy & Execution

  • Own end-to-end RA strategy across prospective (point-of-care capture, suspecting, provider workflows) and retrospective (chart review, coding validation) programs, ensuring complete, accurate, and compliant HCC documentation under the applicable CMS-HCC model (including V24 -V28 transition management).
  • Evaluate current vendor performance, renegotiating or sunsetting SOWs where internal capability is superior.
  • Serve as the plan-side counterpart to UMMH CDI, HIM, and Coding leadership, coordinating with the CMO's office to embed documentation workflows into Epic-based clinical practice rather than layered on top of it.
  • Partner with Network and Clinical Services to design provider-facing education, scorecards, and incentive structures that drive documentation accuracy without creating coding-driven behavior.
  • Develop provider-level performance reporting that is transparent, defensible, and actionable.

RADV, Audit & Compliance

  • Lead RADV audit readiness and response, including medical record retrieval, validation, submission strategy, and cross-functional coordination with Legal, Compliance, and Finance to mitigate financial and compliance risk.
  • Maintain a comprehensive QA program covering RADV, OIG, and internal audits - monitoring the work of internal coders, contracted vendors, and provider documentation alike.
  • Own encounter data integrity, including EDPS submission accuracy, RAPS/EDPS reconciliation, and error resolution.

Analytics, Finance & Bid Support

  • Build and maintain the RA analytics layer - dashboards, KPIs, and provider/member-level reporting that drive continuous improvement in risk score accuracy, coding yield, and program ROI.
  • Partner with Actuarial and Finance on bid development, producing defensible risk score projections, trend analysis, and revenue assumptions grounded in population severity and program performance.
  • Communicate results to executive and board audiences through clear reports, dashboards, and presentations.

Program & Team Leadership

  • Set departmental goals, budgets, and tactical plans aligned with enterprise strategy and financial targets.
  • Other duties may be assigned as needed. 

* Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.


Requirements

  • Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
  • Registered Nurse (RN) desired. 
  • CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
  • 7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
  • Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the  V24-V28  transition and its financial implications.
  • Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
  • Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.+
  • Strong Microsoft Office skills (Word, Outlook, Excel and PP).


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