Top 221 Registered nurse Jobs in Venezuela Pr

Risk Adjustment and Coding Nurse
TPIS —San Juan, PR
- $55,000 - $65,000 a year
- Temporary
- Spanish
- Nursing
- RN License
Quick Apply
Registered Nurse
Programa Control-V —San Juan, PR
- $28 an hour
- Full-time
- Nursing
- Vital signs
- HIPAA
- Flexible schedule
Quick Apply
4d
Registered Nurse (RN-BSN)
NeoMed Center Inc —Trujillo Alto, PR
- $20.72 - $22.88 an hour
- Overnight shift
- Dental insurance
- 401(k)
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
Intake RN (San Juan)
Revival Home Health Care a Centers Company —San Juan, PR
- Full-time
- Mid-level
- Home Health
- Discharge planning
Quick Apply
RN Clinical Case Manager (San Juan, PR)
Healthmap Solutions Puerto Rico —San Juan, PR
- Full-time
- Hybrid work
- Spanish
- Nursing
- Microsoft Excel
6d
Especialista en Revision Medica
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
OASIS Reviewer
Revival Home Health Care a Centers Company —San Juan, PR
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
Enfermero(a) Generalista - RN
Hospital Oncológico —San Juan, PR
- Full-time
- In-person
Quick Apply
14d
Especialista De Manejo De Utilización
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
1d
Especialista En Revisión De Utilización Hospitalaria
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
1d
Especialista De Determinaciones Organizacionales Y Apelaciones
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
Clinical Research Nurse, RN
Headlands Research —San Juan, PR
- Full-time
- Spanish
- Patient monitoring
- RN License
- Health savings account
- Paid holidays
Quick Apply
Registered Nurse (RN)
PROVIDER NETWORK SOLUTIONS OF PUERTO RICO LLC —San Juan, PR
- Full-time
- Home Health
- 401(k)
Quick Apply
13d
Especialista De Revisión Clínica - Temporero(a)
MCS HEALTHCARE HOLDINGS, LLC —San Juan, PR
- Spanish
- Nursing
- RN License
RN Clinical Manager
Revival Home Health Care a Centers Company —San Juan, PR
- Full-time
- Nursing
- Mid-level
- Recruiting
Quick Apply
Outpatient Registered Nurse - RN
Fresenius Medical Care —Bayamón, PR
- Full-time
- CPR Certification
- Nursing
- Current TB test
6d
Registered Nurse
The Pain Clinic —San Juan, PR
- $15.00 - $17.50 an hour
- Full-time
- RN License
- BLS Certification
- Mid-level
- Employee discount
Quick Apply
1d
Profesor(a) Bachillerato en Ciencias de Enfermería (RN a BSN)
NUC University —San Juan, PR
- Part-time
Quick Apply
VMG-CASE MANAGER-OUTREACH-BAYAMON
Varmed Management —Bayamón, PR
- $38,000 - $38,500 a year
- Full-time
Quick Apply

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registered nurse jobs near venezuela 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

registered nurse jobs in venezuela pr

Risk Adjustment and Coding Nurse

Registered Nurse

Registered Nurse (RN-BSN)

Registered Nurse - Home Visits

Intake RN (San Juan)

RN Clinical Case Manager (San Juan, PR)

Especialista en Revision Medica

OASIS Reviewer

Enfermero(a) Generalista - RN

Especialista De Manejo De Utilización

Especialista En Revisión De Utilización Hospitalaria

Especialista De Determinaciones Organizacionales Y Apelaciones

Clinical Research Nurse, RN

Registered Nurse (RN)

Especialista De Revisión Clínica - Temporero(a)

RN Clinical Manager

Outpatient Registered Nurse - RN

Registered Nurse

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

VMG-CASE MANAGER-OUTREACH-BAYAMON

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