Top 344 Nursing occupations Jobs in Caguas, Pr

Risk Adjustment and Coding Nurse
TPIS —San Juan, PR
- $55,000 - $65,000 a year
- Temporary
- Spanish
- Nursing
- RN License
Quick Apply
Enfermera Generalista o Asociado - Aguas Buenas
Pediatric Home Care Services, LLC. —Aguas Buenas, PR
- $14.45 - $17.35 an hour
- Contract
- Background check
- Nursing
- RN License
Quick Apply
1d
RN Clinical Reviewer (CPC Medical Coding Academy) - San Juan, PR
UnitedHealth Group —San Juan, PR
- Full-time
- RN License
- Medical office experience
- Pass drug screening
12d
Enfermero(a) de Salud Ocupacional – Industria Farmacéutica
Neolpharma Inc. —Caguas, PR
1d
Registered Nurse (RN-BSN)
NeoMed Center Inc —Gurabo, PR
- $20.72 - $22.88 an hour
- Overnight shift
- Dental insurance
- 401(k)
Quick Apply
Enfermera graduada
CRC Research —Caguas, PR
- $13 - $16 an hour
- Contract
- Nursing
- In-person
- Epic
Quick Apply
Enfermera
Laboratorios Clínicos Villa Ana —Caguas, PR
- Full-time
- In-person
Quick Apply
Registered Nurse
Programa Control-V —San Juan, PR
- $28 an hour
- Full-time
- Nursing
- Vital signs
- HIPAA
- Flexible schedule
Quick Apply
4d
Enfermero(a) Registrado(a)
Grace Health of Puerto Rico —Caguas, PR
- From $36,000 a year
- Full-time
- CPR Certification
- Nursing
- BLS Certification
- Health insurance
- Paid time off
Quick Apply
8d
Bsn
Fresenius —San Juan, PR
- $37.65 - $45.35 an hour
- Full-time
Quick Apply
13d
Director of Nursing
NeoMed Center Inc —Gurabo, PR
- $24.69 - $26.07 an hour
- Extended hours
- CPR Certification
- Nursing
- PALS Certification
- Free parking
- Continuing education credits
Quick Apply
Especialista en Revision Medica
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
Enfermera Generalista
Hospital Pavia Caguas —Caguas, PR
- From $2,750 a month
- Full-time
- Nursing
- BLS Certification
- ACLS Certification
- Health insurance
Quick Apply
8d
Intake RN (San Juan)
Revival Home Health Care a Centers Company —San Juan, PR
- Full-time
- Mid-level
- Home Health
- Discharge planning
Quick Apply
Registered Nurse - Home Visits
Alura Workforce Solutions —San Juan, PR
- $45 an hour
- Part-time
- Patient monitoring
- RN License
- Mid-level
Quick Apply
OASIS Reviewer
Revival Home Health Care a Centers Company —San Juan, PR
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
Enfermero(a) Intensivista
Centro Comprensivo del Cancer UPR —San Juan, PR
- From $3,500 a month
- Full-time
Quick Apply
Enfermero-a Generalista SL Metro Cupey
HOSPITAL EPISCOPAL SAN LUCAS METRO —Cupey, PR
- $35,999.99 - $36,000.00 an hour
- Full-time
Quick Apply
7d
Enfermero(a) Graduado(a) Generalista
Centro Comprensivo del Cancer UPR —San Juan, PR
- From $3,100 a month
- Full-time
Quick Apply
14d
Especialista De Manejo De Utilización
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
2d

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nursing occupations jobs near caguas, pr

Risk Adjustment and Coding Nurse

TPIS -
San Juan, PR

Quick Apply

Job Details

Temporary
$55,000 - $65,000 a year

Qualifications

Spanish
Nursing
RN License
English
Driver's License
Bachelor's degree
Bachelor's degree in nursing
Nursing

Full Job Description

We are looking for a clinical nurse that will be responsible for performing clinical quality assessments and documentation reviews across the Classicare provider network to ensure compliance with the Center for Medicare and Medicaid Services (CMS), Healthcare Effectiveness Data and Information Set (HEDIS), and internal standards. Validates diagnoses, assesses documentation quality, and promotes accurate risk adjustment coding practices. Provides targeted education to providers, helping them improve documentation practices and align with regulatory and organizational requirements.

ESSENTIAL FUNCTIONS:

Coordinate with provider offices to request medical records and schedule onsite or virtual visits for documentation review.
Develop and maintain a detailed work plan outlining scheduled and completed clinical review activities.
Conducts quality assessments, HEDIS evaluations, and Premium Management reviews, adhering to established company policies and procedures.
Review medical records to validate diagnosis coding accuracy and ensure clinical documentation supports submitted diagnoses.
Communicate findings directly with providers and/or office administrators, offering constructive feedback and clinical education as needed.
Identify documentation gaps or educational opportunities and deliver customized training on clinical documentation improvement, accurate coding, and compliance with CMS and HEDIS guidelines.
Recommend and develop Corrective Action Plans (CAPs) for providers who fall short of documentation and coding standards.
Serve as a liaison between providers and the Premium Management department, maintaining ongoing, professional communication to support collaborative improvement.
Report activities, including completed audits and education provided, to the management.
Identify and escalate potential risks or issues related to premium management processes and suggest improvements to enhance service quality and performance.
Adhere strictly to ethical standards, HEDIS/STARS specifications, and regulatory guidelines established by Medicare, Medicaid, National Committee for Quality Assurance (NCQA), and internal clinical protocols.

REQUIREMENTS:

Bachelor’s Degree in Nursing Science.
At least three (3) years of experience in risk adjustment, coding, provider healthcare management, or clinical experience in a similar position in the Healthcare Insurance Industry is preferred.
valid Nurse & Association Nursing Professionals of Puerto Rico license and registration is required.
A valid driver's license in the Commonwealth of Puerto Rico is required.
Must be available to visit medical offices in the following municipalities: San Juan, Guaynabo, Aguas Buenas, Cidra, Caguas, Cayey

Languages:

Spanish Intermediate (conversational, writing, and comprehension)

English Intermediate (conversational, writing, and comprehension)

Required availability:

Monday to Friday, 8:00am - 4:30pm (rotating schedules)

Hybrid Modality

Compensation :

up to $65,000k annually

This is a temporary job assignment until December, 2026.

TPIS is an employer with equal opportunity in employment and take Affirmative Action to Recruit Women, Minorities, Protected Veterans, and Persons with Disabilities.

Quick Apply

Refine Your Search

nursing occupations jobs in caguas, pr

Risk Adjustment and Coding Nurse

Enfermera Generalista o Asociado - Aguas Buenas

RN Clinical Reviewer (CPC Medical Coding Academy) - San Juan, PR

Enfermero(a) de Salud Ocupacional – Industria Farmacéutica

Registered Nurse (RN-BSN)

Enfermera graduada

Enfermera

Registered Nurse

Enfermero(a) Registrado(a)

Bsn

Director of Nursing

Especialista en Revision Medica

Enfermera Generalista

Intake RN (San Juan)

Registered Nurse - Home Visits

OASIS Reviewer

Enfermero(a) Intensivista

Enfermero-a Generalista SL Metro Cupey

Enfermero(a) Graduado(a) Generalista

Especialista De Manejo De Utilización

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