Clinical Quality Advisor

Clinical Quality Advisor CareBridge Health is part of the Elevance Health family, under our Carelon business. We are dedicated to empowering individuals in home and community-based settings, helping them to achieve optimal health, independence, and a high quality of life through essential home-care and community services. Virtual Work Environment: This role offers the flexibility of full-time virtual work with occasional in-person training sessions for optimal onboarding and skill development. Our approach fosters productivity and supports work-life balance. Candidates residing within commuting distance of our office may be considered for alternate locations. Please note that, in accordance with our policies on hybrid and virtual work, candidates outside a reasonable commuting distance will not be considered unless legally required accommodations are granted. Work Schedule: Monday through Friday, 8 AM to 5 PM local time. No weekends or holidays. The Clinical Quality Advisor plays a critical role in ensuring quality documentation, coding, and value capture. Key Responsibilities: Conduct comprehensive chart reviews, providing clinical expertise to guarantee accurate diagnosis, documentation, coding, and care. Review all provider visit medical encounters, ensuring application of the most appropriate diagnosis codes. Be accountable for HCC/Risk Adjustment goals and workflows, enhancing value capture initiatives and ensuring high-quality clinical documentation. Serve as a liaison to the coding team. Identify and close HEDIS care opportunities through chart reviews, supporting practice and health plan success. Engage in peer reviews of medical documentation, focusing on visit notes and patient profile information within the EMR. Examine and correct any assigned ICD-10 codes in patient charts. Provide insightful feedback to providers on enhancing documentation to support specific codes. Minimum Requirements: A Master’s degree in Nursing and a minimum of 3 years of experience in the Medicare HCC model and/or CMS Risk Adjustment Model, or an equivalent combination of education and experience. A current, valid, and unrestricted RN license and NP license in applicable states. Multi-state licensure is necessary for services provided across multiple states. A satisfactory completion of a Tuberculosis test is a requisite for this position. Preferred Skills and Qualifications: Preferential consideration for AAPC Certified Risk Adjustment Coder certification. For candidates within the specified location, the salary range for this position is $120,640 to $150,800, based on experience and qualifications. In addition to a competitive salary, Elevance Health provides a comprehensive benefits package, including equity stock purchase options and 401(k) contributions (subject to eligibility). We are committed to offering equal pay opportunities regardless of gender, race, or other protected categories. The salary range provided is based on current company evaluations and may be adjusted in the future to reflect market conditions and individual qualifications. Elevance Health operates a Hybrid Workforce Strategy. Associates are typically required to work onsite at least once per week unless otherwise specified. Specific onsite requirements will be discussed during the hiring process. Our commitment to health and safety requires all new employees in certain roles to be vaccinated against COVID-19 and Influenza, and exceptions may apply in accordance with applicable laws. Elevance Health is an Equal Employment Opportunity employer, ensuring all qualified applicants are considered for employment without regard to protected statuses. Candidates needing accommodation during the application process may contact Elevance Health's recruitment support for assistance. We also consider qualified applicants with arrest or conviction records in line with all relevant laws.

Created: 2026-03-06