Clinical Quality Consultant NP 100% Virtual, CareBridge

Elevance Health; Nashville (TN); Remote; USD 80,000 - 120,000; Full time

Job summary

A leading healthcare services provider is seeking a Nurse Practitioner to support HCC and Risk Adjustment initiatives through chart reviews and coding. The role offers comprehensive benefits and a remote work model to ensure flexibility and work-life balance. Ideal candidates will have an MS in Nursing, three years of relevant experience, and active RN/NP licenses.

Benefits

Comprehensive benefits package

Incentive bonus programs

Paid time off

Supportive work environment

Qualifications

• Minimum 3 years of experience with Medicare HCC model.
• Must have current, valid RN and NP licenses.
• Strong understanding of STAR/HEDIS.

Responsibilities

• Conduct chart reviews for accurate coding and diagnosis.
• Oversee HCC/Risk Adjustment workflows.
• Liaise with coding team for documentation practices.

Skills

Critical thinking

Risk Adjustment knowledge

Understanding of STAR/HEDIS

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 full-time with maximum flexibility
- Comprehensive benefits package including medical, dental, vision, and wellness programs
- Incentive bonus programs and paid time off
- Supportive and collaborative work environment that promotes work-life integration

What to Expect (Job Responsibilities):
- Conduct chart reviews to ensure accurate diagnosis, documentation, coding, and care
- Oversee HCC/Risk Adjustment goals and workflows to support value capture initiatives
- Close HEDIS care opportunities through thorough chart reviews
- Liaise with the coding team and provide feedback to improve documentation practices
- Review and correct ICD-10 codes assigned in medical charts

What is Required (Qualifications):
- Must possess an MS in Nursing and a minimum of 3 years of experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model
- Current, active, valid, and unrestricted RN and NP licenses in applicable state(s)
- Strong understanding of STAR/HEDIS and Risk Adjustment payment models

How to Stand Out (Preferred Qualifications):
- AAPC Certified Risk Adjustment Coder certification
- Up-to-date knowledge of the latest CMS coding and documentation requirements

#HealthcareServices #NursePractitioner #RemoteWork #CareerGrowth #QualityCare

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