Clinical Quality Consultant NP
About The Position
The Clinical Quality Consultant NP will be responsible for quality documentation, coding and value capture. This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Requirements
- Requires an MS in Nursing and minimum of 3 years experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model; or any combination of education and experience, which would provide an equivalent background.
- Requires a current, active, valid and unrestricted RN license and NP license in applicable state(s).
- Multi-state licensure is required if this individual is providing services in multiple states.
- For Carelon Health, satisfactory completion of a Tuberculosis test is a requirement for this position.
- Travels to worksite and other locations as necessary.
Nice To Haves
- Prefer AAPC Certified Risk Adjustment Coder
Responsibilities
- Focus on chart reviews by supplying clinical expertise to ensure full accurate and appropriate diagnosis, documentation, coding and care.
- Review all provider visit medical encounters and apply most appropriate diagnosis codes.
- Overall accountability for the HCC/Risk Adjustment of goals and workflows to support value capture initiatives and high-quality clinical documentation.
- Chart reviews for closing HEDIS care opportunities.
- Liaison to coding team.
- Chart reviews for closing HEDIS care opportunities to ensure practice and health plan success.
- Participate in peer review of medical documentation for completed visit notes and patient profile information in EMR.
- Reviews and corrects any ICD-10 codes that have been assigned in charts.
- Provide feedback to the provider for improved documentation to support specific codes.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
