Nurse Practitioner – Clinical Quality Consultant

Elevance Health

. Perform chart reviews using clinical expertise to ensure accurate diagnosis, documentation, coding and care .

Posted 10/6/2026full-timeUnited StatesMid-LevelSenior💰 $120,640 - $180,960 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical documentation, coding accuracy, and risk adjustment methodologies, particularly within the Medicare HCC model. Proficient in conducting chart reviews and providing feedback to enhance documentation quality and compliance.

Highest-signal resume keywords

MS In NursingRN LicenseNP LicenseHCC/Risk Adjustment ExperienceAAPC Certified Risk Adjustment Coder

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10 CodingChart ReviewClinical DocumentationDiagnosis CodingHEDIS Care Opportunities

Soft Skills

Attention To DetailCommunicationCollaboration

Tools & Technologies

EMR

Certifications & Qualifications

AAPC Certified Risk Adjustment Coder

Industry Keywords

MedicareCMS Risk Adjustment ModelValue Capture InitiativesMulti-State LicensureTuberculosis Test

About the role

Key responsibilities & impact

Perform chart reviews using clinical expertise to ensure accurate diagnosis, documentation, coding and care
Review provider visit medical encounters and apply the most appropriate diagnosis codes
Maintain accountability for HCC/Risk Adjustment goals and workflows supporting value capture initiatives and high-quality clinical documentation
Conduct chart reviews to close HEDIS care opportunities
Liaise with the coding team
Participate in peer review of medical documentation for completed visit notes and patient profile information in the EMR
Review and correct ICD-10 codes assigned in charts
Provide provider feedback to improve documentation supporting specific codes

Requirements

What you’ll need

Requires an MS in Nursing
Minimum of 3 years experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model
Current, active, valid and unrestricted RN license in applicable state(s)
Current, active, valid and unrestricted NP license in applicable state(s)
Multi-state licensure is required if providing services in multiple states
Satisfactory completion of a Tuberculosis test
Travel to worksite and other locations as necessary
Prefer AAPC Certified Risk Adjustment Coder
Candidates must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
COVID-19 and Influenza vaccination required for certain patient/member-facing roles unless an acceptable explanation is provided

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) with match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual work flexibility
Professional growth opportunities