Clinical Quality Consultant 100% Virtual, CareBridge
About The Position
Clinical Quality Consultant CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services. Virtual: This role enables associates to work virtually full-time, with the exception of 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. Work Shift: Monday through Friday, 8AM to 5PM local time. No weekends or holidays. The Clinical Quality Consultant is responsible for quality documentation, coding and value capture.
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.
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.
- Will 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.
- 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
- Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs (unless covered by a collective bargaining agreement)
- medical, dental, vision, short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs and financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
