Top 198 Registered nurse Jobs in Gurabo Pr

Clinical Review Specialist
TPIS —San Juan, PR
- $55,000 - $65,000 a year
- Monday to Friday
- Spanish
- Nursing
- RN License
Quick Apply
Registered Nurse (RN-BSN)
NeoMed Center Inc —Gurabo, PR
- $20.72 - $22.88 an hour
- Overnight shift
- Dental insurance
- 401(k)
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3d
Registered Nurse
Wellness Institute of Neurodevelopment —Guaynabo, PR
- Weekends as needed
- Spanish
- CPR Certification
- Nursing
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11d
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
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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 (RN)
Business Staffing Solution —Aibonito, PR
- From $30 an hour
- 12 hour shift
- Nursing
- Vital signs
- Management
Quick Apply
10d
RN Clinical Manager
Revival Home Health Care a Centers Company —San Juan, PR
- Full-time
- Nursing
- Mid-level
- Recruiting
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Registered Nurse - Home Visits
Alura Workforce Solutions —San Juan, PR
- $45 an hour
- Part-time
- Patient monitoring
- RN License
- Mid-level
Quick Apply
Profesor(a) Bachillerato en Ciencias de Enfermería (RN a BSN)
NUC University —Caguas, PR
- Part-time
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Outpatient Registered Nurse - RN
Fresenius Medical Care —Canovanas, PR
- Full-time
- CPR Certification
- Nursing
- Current TB test
4d
Clinical Research Nurse, RN
Headlands Research —San Juan, PR
- Full-time
- Spanish
- Patient monitoring
- RN License
- Health savings account
- Paid holidays
Quick Apply
Nursing Informatics Specialist
Infomedika, Inc —San Juan, PR
- $36,000 - $42,000 a year
- Full-time
- Health insurance
- Dental insurance
Quick Apply
OASIS Reviewer
Revival Home Health Care a Centers Company —San Juan, PR
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
RN Clinical Inpatient Reviewer (CIC Coding Academy) - San Juan, PR
Optum —San Juan, PR
- Full-time
- RN License
- Pass drug screening
- Research
Registered Nurse
Solace Clinical Research —Bayamón, PR
- $13 - $16 an hour
- Full-time
- Vital signs
- Urgent Care
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
Enfermero/a Generalista Servicio Profesionales
Hospital Menonita Guayama —Guayama, PR
- $17.30 an hour
- Contract
- CPR Certification
- Nursing
- Anatomy knowledge
Quick Apply
Especialista en Revision Medica
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
10d
Supervisor(a) de Enfermería - (Turnos de 12 horas)
San Juan Capestrano —Rio Piedras, PR
- Full-time
- CPR Certification
- Nursing
- RN License
Enfermera RN - San Juan
Pediatric Home Care Services, LLC. —San Juan, PR
- $14.45 - $17.35 an hour
- Contract
- Background check
- CPR Certification
- Nursing
Quick Apply
Director of Cardiovascular
United Pro Search —Carolina, PR
- $138,000 - $170,000 a year
- Full-time
- RN License
- Hospital
- BLS Certification

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registered nurse jobs near gurabo pr

Clinical Review Specialist

TPIS -
San Juan, PR

Quick Apply

Job Details

$55,000 - $65,000 a year

Qualifications

Spanish
RN License
English
Driver's License
Bachelor of Science in Nursing
Bachelor's degree in nursing
Constructive feedback for students

Full Job Description

We are looking for a clinical administrative support role 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

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

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Refine Your Search

registered nurse jobs in gurabo pr

Clinical Review Specialist

Registered Nurse (RN-BSN)

Registered Nurse

Director of Nursing

Intake RN (San Juan)

Registered Nurse (RN)

RN Clinical Manager

Registered Nurse - Home Visits

Profesor(a) Bachillerato en Ciencias de Enfermería (RN a BSN)

Outpatient Registered Nurse - RN

Clinical Research Nurse, RN

Nursing Informatics Specialist

OASIS Reviewer

RN Clinical Inpatient Reviewer (CIC Coding Academy) - San Juan, PR

Registered Nurse

Enfermero/a Generalista Servicio Profesionales

Especialista en Revision Medica

Supervisor(a) de Enfermería - (Turnos de 12 horas)

Enfermera RN - San Juan

Director of Cardiovascular

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