Nurse Practitioner – Clinical Quality & HCC/Risk Adjustment

Elevance Health, Inc.; Nashville (TN); Hybrid; USD 121,000 - 181,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

401(k) contribution

Job summary

Elevance Health, Inc. seeks a Nurse Practitioner Clinical Quality Consultant to ensure accurate documentation, coding and value capture across Medicare HCC programs.

The role emphasizes chart reviews, ICD-10 coding optimization, and collaboration with the coding team to improve HEDIS performance. The position supports a hybrid/remote work setup with required in-person training sessions and occasional travel to office locations, including Ohio sites.

Qualifications

• MS in Nursing with at least 3 years in Medicare HCC or CMS Risk Adjustment.
• Active RN license and NP license in applicable state(s); multi-state licensure if needed.
• Willingness to travel to worksite and other locations as necessary.

Responsibilities

• Conduct chart reviews to ensure accurate diagnosis, documentation, coding and care.
• Review provider visit encounters and assign appropriate ICD-10 codes.
• Own HCC/Risk Adjustment goals and workflows to support value capture.
• Close HEDIS opportunities through chart reviews.
• Liaise with coding team and provide documentation feedback.
• Participate in peer review of medical documentation.
• Review and correct ICD-10 codes in charts.

Skills

Nurse Practitioner

Clinical quality

Chart reviews

HCC/Risk Adjustment

Education

MS in Nursing

Tools

EMR

Job description

Elevance Health, Inc. seeks a Nurse Practitioner Clinical Quality Consultant to ensure accurate documentation, coding and value capture across Medicare HCC programs.

The role emphasizes chart reviews, ICD-10 coding optimization, and collaboration with the coding team to improve HEDIS performance. The position supports a hybrid/remote work setup with required in-person training sessions and occasional travel to office locations, including Ohio sites.