Nurse Practitioner Clinical Quality Consultant

The Elevance Health Companies, Inc.; Brooklyn Heights (TN); Hybrid; USD 121,000 - 181,000; Full time

Benefits offered by this job

Benefits package

401(k) + match

Stock purchase plan

Paid time off

Incentive bonus programs

Wellness programs

Job summary

Elevation Health seeks a Nurse Practitioner Clinical Quality Consultant to enhance documentation, coding, and risk adjustment accuracy across Medicare pathways. This remote-friendly role emphasizes chart reviews, provider feedback, and collaboration with the coding team to optimize HCC outcomes and HEDIS opportunities.

Role requires MS in Nursing and active NP/RN licenses (multi-state licensure often needed).

Qualifications

• MS in Nursing with clinical focus and Medicare HCC experience.
• Current, active RN and NP licenses in applicable states; multi-state licensure required if practicing in multiple states.
• Satisfactory completion of a Tuberculosis screen as required by Carelon Health.

Responsibilities

• Perform chart reviews to ensure accurate diagnosis coding and documentation.
• Review provider visit encounters and assign appropriate ICD-10 codes.
• Account for HCC/Risk Adjustment goals to support value capture and high-quality documentation.
• Conduct chart reviews to close HEDIS care opportunities and liaise with coding team.
• Provide feedback to providers to improve documentation for specific codes.

Skills

HCC risk adjustment

Multistate licensure

Nursing MS

Education

MS in Nursing

RN license

Job description

Position Title

Nurse Practitioner Clinical Quality Consultant

Anticipated End Date

2026-11-20

Job Description

This role enables associates to work virtually full-time, except for 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 accommodation is granted as required by law.

The Nurse Practitioner Clinical Quality Consultant is responsible for quality documentation, coding and value capture.

How you’ll make a difference:

• 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.
• Chart reviews for closing HEDIS care opportunities.
• 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.

Minimum 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.
• Travels to worksite and other locations as necessary.

Preferred Skills, Qualifications and Experience

• Prefer AAPC Certified Risk Adjustment Coder

Locations

Cleveland, OH; Columbus, OH;

Salary

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $120,640 to $180,960

Benefits

In addition to your salary, 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).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level

Non-Management Exempt

Job Family

MED > Licensed Nurse

About the Company

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and 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, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Equal Employment Opportunity Statement

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Elevance Health is an Equal Opportunity Employer/Disability/Veterans.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.