Clinical Quality Consultant, NP

Elevance Health

Clinical Quality Consultant NP ensuring full accurate diagnosis and appropriateness of clinical documentation for Elevance Health. Reviewing medical encounters and providing coding expertise for quality care delivery.

Posted 6/16/2026full-timeGrand Prairie • Texas • 🇺🇸 United StatesMid-LevelSenior💰 $114,608 - $199,056 per yearWebsite

About the role

Key responsibilities & impact

Focus on chart reviews by supplying clinical expertise to ensure full accurate and appropriate diagnosis, documentation, coding and care
Review provider visit medical encounters and apply appropriate diagnosis codes
Overall accountability for HCC/Risk Adjustment goals and workflows to support value capture initiatives and high-quality clinical documentation
Chart reviews for closing HEDIS care opportunities
Liaison to coding team
Participate in peer review of medical documentation for completed visit notes and patient profile information in EMR
Review and correct ICD-10 codes assigned in charts
Provide feedback to providers for improved documentation to support 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 and NP license in applicable state(s)
Multi-state licensure is required if providing services in multiple states
Prefer AAPC Certified Risk Adjustment Coder

Benefits

Comp & perks

Health insurance
401(k) matching
Paid time off
Flexible work arrangements
Professional development opportunities
Equity stock purchase
Incentive and recognition programs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

ICD-10 codingclinical documentationHCC/Risk AdjustmentHEDIS care opportunitiesmedical codingpeer reviewdiagnosis codingdocumentation improvementvalue capture initiativesEMR

Soft Skills

clinical expertisecommunicationfeedback provisioncollaborationaccountability

Certifications

MS in NursingRN licenseNP licenseAAPC Certified Risk Adjustment Coder