Clinical Quality Consultant NP

Skip to main contentWe care about your privacyBy clicking "Accept All", you agree to the storing of cookies on your device to give you the most optimal experience using our website. We may also use cookies to enhance performance, analyze site usage and to personalize your experience.Read Full Privacy MessageDeclineAccept CookiesCareers at Elevance HealthEnglishSign InClinical Quality Consultant NP page is loadedClinical Quality Consultant NPApplylocationsTX-GRAND PRAIRIE, 2505 N HWY 360, STE 200 & 300GeorgiaMinnesotatime typeFull timeposted onPosted 30+ Days Agotime left to applyEnd Date: July 31, 2026 (9 days left to apply)job requisition idJR196980Anticipated End Date:2026-07-31Position Title:Clinical Quality Consultant NPJob Description:Location: Virtual: 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 an accommodation is granted as required by law.Responsible for quality documentation, coding and value capture.  How You'll Make a Difference:Primary duties may include, but are not limited to: 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 experiences:Prefer AAPC Certified Risk Adjustment CoderFor candidates working in person or virtually in the below location(s), the salary* range for this specific position is $114,608 to $199.056  Locations: Minnesota   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...