Clinical Quality Consultant NP 100% Virtual, CareBridge

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.

CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services. Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. 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. Work Shift: Monday – Friday, 8:00 am to 5:00 pm The Clinical Quality Consultant NP is responsible for quality documentation, coding and value capture.

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 to ensure practice and health plan success. Liaison to coding team. 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.