Nurse Practitioner Clinical Quality Consultant

Elevance Health • Nashville, TN

5d • Remote

About The Position

The Nurse Practitioner Clinical Quality Consultant is responsible for quality documentation, coding, and value capture. The role provides clinical expertise through chart reviews to support accurate and appropriate diagnoses, documentation, coding, and care. The consultant reviews provider visit encounters, supports HCC/Risk Adjustment goals and workflows, helps close HEDIS care opportunities, and serves as a liaison to the coding team. The role also includes peer review of completed visit notes and patient profile information in the EMR, correcting assigned ICD-10 codes, and providing providers with feedback to improve documentation.

The role is virtually full-time, with required in-person training sessions. Alternate locations may be considered for candidates within commuting distance of an office; candidates outside a reasonable commuting distance generally will not be considered unless accommodation is granted as required by law. Travel to the worksite and other locations is required as necessary. For Carelon Health, satisfactory completion of a tuberculosis test is required.

Requirements

• Master of Science in Nursing and at least 3 years of experience applying appropriate diagnoses in the Medicare HCC model and/or CMS Risk Adjustment Model, or an equivalent combination of education and experience.
• Current, active, valid, unrestricted RN license and NP license in applicable state(s).
• Multi-state licensure if providing services in multiple states.
• Satisfactory completion of a tuberculosis test for Carelon Health.
• Ability to travel to the worksite and other locations as necessary.

Nice To Haves

• AAPC Certified Risk Adjustment Coder.

Responsibilities

• Review provider visit medical encounters and apply the most appropriate diagnosis codes.
• Conduct chart reviews to ensure accurate and appropriate diagnoses, documentation, coding, and care.
• Support HCC/Risk Adjustment goals and workflows for value capture initiatives and high-quality clinical documentation.
• Review charts to close HEDIS care opportunities and support practice and health plan success.
• Serve as a liaison to the coding team.
• Participate in peer review of medical documentation, completed visit notes, and patient profile information in the EMR.
• Review and correct ICD-10 codes assigned in charts.
• Provide providers with feedback to improve documentation supporting specific codes.
• Travel to the worksite and other locations as necessary.

Benefits

• Comprehensive benefits package, subject to eligibility requirements.
• Incentive and recognition programs.
• Equity stock purchase plan.
• 401(k) contribution.
• Merit increases.
• Paid holidays.
• Paid time off.
• Incentive bonus programs, unless covered by a collective bargaining agreement.
• Medical benefits.
• Dental benefits.
• Vision benefits.
• Short- and long-term disability benefits.
• 401(k) match.
• Life insurance.
• Wellness programs.
• Financial education resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level