Nurse Practitioner Clinical Quality Consultant
About The Position
The Nurse Practitioner Clinical Quality Consultant is responsible for quality documentation, coding, and value capture. The position focuses on reviewing charts and provider medical encounters to ensure accurate and appropriate diagnoses, documentation, coding, and care. It supports HCC/Risk Adjustment goals and workflows, value capture initiatives, and high-quality clinical documentation, while helping close HEDIS care opportunities. The role also liaises with the coding team, participates in peer reviews of medical documentation and EMR patient profiles, corrects assigned ICD-10 codes, and gives providers feedback to improve documentation. The role is virtually full-time, with required in-person training sessions. Candidates must be within a reasonable commuting distance of the posting location(s), unless an accommodation is granted as required by law. Travel to the worksite and other locations is required as necessary. Locations listed for the salary range are Cleveland and Columbus, Ohio.
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, and unrestricted RN license and NP license in applicable state(s).
- Multi-state licensure if providing services in multiple states.
- For Carelon Health, satisfactory completion of a tuberculosis test.
Nice To Haves
- AAPC Certified Risk Adjustment Coder.
Responsibilities
- Review charts using clinical expertise to ensure accurate and appropriate diagnoses, documentation, coding, and care.
- Review provider visit medical encounters and apply the most appropriate diagnosis codes.
- Maintain accountability for HCC/Risk Adjustment goals and workflows that support value capture initiatives and high-quality clinical documentation.
- Review charts to close HEDIS care opportunities and support practice and health plan success.
- Act as a liaison to the coding team.
- Participate in peer review of 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 in support of 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.
- 401(k) contribution.
- Merit increases.
- Paid holidays.
- Paid Time Off.
- Incentive bonus programs, unless covered by a collective bargaining agreement.
- Medical insurance.
- Dental insurance.
- Vision insurance.
- 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
