Top 313 Nursing occupations Jobs in Carolina, Pr

Risk Adjustment and Coding Nurse
TPIS —San Juan, PR
- $55,000 - $65,000 a year
- Temporary
- Spanish
- Nursing
- RN License
Quick Apply
Nurse Care Manager I (NCLEX)
Elevance Health —San Juan, PR
- 8 hour shift
- Nursing
- RN License
- Bachelor of Science
- Employee stock purchase plan
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Fresenius —San Juan, PR
- $37.65 - $45.35 an hour
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8d
Registered Nurse - Home Visits
Alura Workforce Solutions —San Juan, PR
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- Mid-level
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Registered Nurse (RN-BSN)
NeoMed Center Inc —Trujillo Alto, PR
- $20.72 - $22.88 an hour
- Overnight shift
- Dental insurance
- 401(k)
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Outpatient Registered Nurse - RN
Fresenius Medical Care —Canovanas, PR
- Full-time
- CPR Certification
- Nursing
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1d
Especialista en Revision Medica
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
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- RN License
Enfermero(a) Intensivista
Centro Comprensivo del Cancer UPR —San Juan, PR
- From $3,500 a month
- Full-time
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Admitting Nurse
Alivia Health —Guaynabo, PR
- Full-time
- Nursing
- RN License
- Mid-level
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2d
Enfermero-a Generalista SL Metro Cupey
HOSPITAL EPISCOPAL SAN LUCAS METRO —Cupey, PR
- $35,999.99 - $36,000.00 an hour
- Full-time
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Intake RN (San Juan)
Revival Home Health Care a Centers Company —San Juan, PR
- Full-time
- Mid-level
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ENFERMERA GENERALISTA SALA DE EMERGENCIAS
Hospital UPR- Dr. Federico Trilla, Carolina —Carolina, PR
- Full-time
- Background check
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OASIS Reviewer
Revival Home Health Care a Centers Company —San Juan, PR
- Full-time
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Enfermero(a) Graduado(a) Generalista
Centro Comprensivo del Cancer UPR —San Juan, PR
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Enfermera Flevotomista
A Medical Group —San Juan, PR
- $15 an hour
- Weekends as needed
- Private practice
- Anatomy knowledge
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Especialista En Revisión De Utilización Hospitalaria
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
5d
Especialista De Manejo De Utilización
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
5d
Enfermera (o) Asociada (o) Vacunaciones Externas San Juan
Vacunas Bright Center —San Juan, PR
- $15 - $18 an hour
- Temporary
Quick Apply
1d
Enfermera Graduada – Grado Asociado en Enfermería
Research Center —San Juan, PR
- $14 - $16 an hour
- Part-time
- Nursing
- Vital signs
- RN License
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4d

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nursing occupations jobs near carolina, 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 carolina, pr

Risk Adjustment and Coding Nurse

Nurse Care Manager I (NCLEX)

Bsn

Registered Nurse

Registered Nurse - Home Visits

Registered Nurse (RN-BSN)

Outpatient Registered Nurse - RN

Especialista en Revision Medica

Enfermero(a) Intensivista

Admitting Nurse

Enfermero-a Generalista SL Metro Cupey

Intake RN (San Juan)

ENFERMERA GENERALISTA SALA DE EMERGENCIAS

OASIS Reviewer

Enfermero(a) Graduado(a) Generalista

Enfermera Flevotomista

Especialista En Revisión De Utilización Hospitalaria

Especialista De Manejo De Utilización

Enfermera (o) Asociada (o) Vacunaciones Externas San Juan

Enfermera Graduada – Grado Asociado en Enfermería

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