Remote NP: Clinical Quality & Documentation Specialist

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

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).