Clinical Quality Consultant NP 100% Virtual, CareBridge

Elevance Health; Indianapolis (IN); Remote; USD 80,000 - 120,000; Full time

Job summary

A leading healthcare organization is seeking an RN/NP with strong expertise in nursing and risk adjustment coding. This opportunity allows for remote work with significant career advancement potential while making a positive impact on patient care and community health. Apply your skills in coding and documentation within a flexible work environment and enjoy comprehensive benefits including medical coverage and 401(k) matching.

Benefits

Comprehensive benefits package

Paid Time Off and holidays

Incentive bonus programs

401(k) with employer matching

Qualifications

• Minimum of 3 years in Medicare HCC model and/or CMS Risk Adjustment Model.
• Active RN and NP licenses.
• Ability to apply diagnosis codes effectively.

Responsibilities

• Conduct chart reviews to ensure accurate documentation.
• Oversee HCC/Risk Adjustment goals and workflows.
• Liaise with coding teams and participate in peer reviews.

Skills

Nursing

ICD-10 Coding

Risk Adjustment Coding

Education

MS in Nursing

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely with maximum flexibility and autonomy
- Comprehensive benefits package including medical, dental, and vision coverage
- Paid Time Off and paid holidays
- Incentive bonus programs and 401(k) with employer matching
- Chance to make a positive impact on patient care and community health

What to Expect (Job Responsibilities):
- Conduct chart reviews to ensure accurate documentation, coding, and diagnosis
- Oversee HCC/Risk Adjustment goals and workflows to support value capture initiatives
- Liaise with coding teams and participate in peer reviews of medical documentation
- Review and correct ICD-10 codes assigned in patient charts
- Provide constructive feedback to providers for improved documentation practices

What is Required (Qualifications):
- MS in Nursing and a minimum of 3 years of experience in applying diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model
- Current, active, valid, and unrestricted RN and NP licenses in applicable states
- Proven ability to apply appropriate diagnosis codes effectively

How to Stand Out (Preferred Qualifications):
- AAPC Certified Risk Adjustment Coder certification
- Knowledge of STAR/HEDIS and Risk-adjustment payment models
- Up-to-date knowledge of CMS coding and documentation requirements

#HealthcareServices #RemoteWork #CareerAdvancement #QualityCare #HealthcareProfessionals

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