Full-Time
Nurse Practitioner
Advantmed
1,001-5,000 employees
Risk adjustment and quality analytics provider
Compensation Overview
$100/hr
Akron, OH, USA
In Person
Daily in-home visits within a 55-mile radius of the assigned county; flexible weekday schedule; 1099 PRN.
 Medical, Clinical & Veterinary (1) |
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- Active, unencumbered Nurse Practitioner license in the applicable state
- Comfortable with Electronic Medical Records systems and independent work
- Conduct in home Annual Wellness Visits and chronic condition assessments
- Perform focused histories, exams, vitals, medication reviews, and screenings
- Screenings: Hemoglobin A1C, Spirometry, Kidney Health Evaluation, Diabetic Retinal Exam, Fecal Immunochemical Test
- Educate members on preventive care and chronic disease management
- Document visits in the Electronic Medical Record to support value-based care and risk adjustment
- All assessments are standardized, with training, equipment guidance, and EMR support provided
- 3+ years of patient care experience preferred
- In home or risk adjustment experience preferred
- Willing to obtain additional licensure if needed (supported by Advantmed)
- Willingness to travel within a 55-mile radius of the assigned county (travel expectations)
Advantmed provides healthcare solutions focused on risk adjustment and quality improvement for health plans and providers. Its ELEVATE! Risk Adjustment platform uses analytics to identify members needing health assessments and retrieves medical records to substantiate diagnoses, with in-home, telehealth, and in-office options. The integrated suite combines analytics, record retrieval, risk adjustment coding, and quality reporting to improve risk scores and measure indicators like HEDIS and Star Ratings. By serving Medicare Advantage, Commercial, and Medicaid plans, physician groups, and ACOs, Advantmed aims to improve health outcomes and revenue integrity in value-based care.
Company Size
1,001-5,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Santa Ana, California
Founded
2005
Simplify's Take
What believers are saying
- Vijay Prabhakar's CRO appointment accelerates Medicare Advantage expansion.
- Dr. Matt Lambert enhances in-home assessments for chronic condition gaps.
- NCQA hybrid measure phase-out by 2029 boosts AI-assisted HEDIS workflows.
What critics are saying
- CMS 5.49% Medicare Advantage payment cut erodes HCC coding revenue in 2027.
- Signify Health's 40% market share steals clients via CVS integrated networks.
- DOJ upcoding probes invalidate 20-30% HCC recaptures within 12-24 months.
What makes Advantmed unique
- ELEVATE platform achieves 81% HCC recapture rate through real-time analytics.
- Pay for Quality launches outcome-based HEDIS abstraction on March 5, 2026.
- NCQA-certified HEDIS measures ensure 98+% coding accuracy and compliance.
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Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
Health Savings Account/Flexible Spending Account
Unlimited Paid Time Off
Flexible Work Hours
Remote Work Options
Paid Vacation
Paid Sick Leave
Paid Holidays
Hybrid Work Options
Stock Options
Company Equity
401(k) Retirement Plan
401(k) Company Match
Performance Bonus
Profit Sharing
Employee Stock Purchase Plan
Relocation Assistance
Employee Referral Bonus
Student Loan Assistance
Parental Leave
Family Planning Benefits
Fertility Treatment Support
Adoption Assistance
Childcare Support
Elder Care Support
Pet Insurance
Bereavement Leave
Professional Development Budget
Conference Attendance Budget
Training Programs
Tuition Reimbursement
Professional Certification Support
Mentorship Program
Wellness Program
Mental Health Support
Gym Membership
Commuter Benefits
Meal Benefits
Phone/Internet Stipend
Home Office Stipend
Legal Services
Employee Discounts
Company Social Events
Company News
Advantmed, a provider of risk adjustment and quality services for health plans, has appointed Vijay Prabhakar as Chief Revenue Officer. Prabhakar brings over 20 years of experience in healthcare revenue growth and sales leadership. In his new role, Prabhakar will oversee Advantmed's commercial strategy, sales, client growth and strategic partnerships to accelerate expansion and strengthen relationships with health plans and providers nationwide. He most recently served as Chief Revenue Officer at RxAnte and previously led payer sales at Signify Health. Founded in 2005, Advantmed provides medical record retrieval, review and health assessment solutions for health plans and providers across Medicare Advantage, Commercial and Medicaid markets.
Advantmed has launched Pay for Quality, an outcome-based HEDIS abstraction solution that allows health plans to pay only for successful, compliant findings rather than per chart reviewed. The company claims this is an industry first. The solution addresses challenges faced by health plans struggling to leverage medical records for quality improvement. Traditional approaches, including AI-enabled solutions, typically charge per chart reviewed and require full clinical validation, creating financial risk without guaranteed outcomes. Advantmed's model eliminates upfront financial risk by charging only when compliant numerators or exclusions are identified. The solution uses proprietary AI-assisted workflows and multi-stage clinical review to ensure accuracy aligned with CMS and NCQA specifications. The launch comes as NCQA transitions away from hybrid measures by 2029, increasing pressure on accurate data capture for Medicare Advantage Star measures.
Advantmed launches Pay for Quality - the industry's first HEDIS Abstraction solution, enabling health plans to Pay for outcomes, not charts. * Business Wire * 1 hr ago IRVINE, Calif.-(BUSINESS WIRE)-Mar 5, 2026- Advantmed, a leading provider of risk adjustment and Quality improvement solutions, today announced the launch of its Pay for Quality: HEDIS Abstraction offering - an industry-first, outcome-based solution that enables health plans and risk-bearing entities (RBEs) to close Healthcare Effectiveness Data and Information Set (HEDIS(R) gaps by paying only for successful, compliant findings. Outcome-based model eliminates financial risk and helps plans close more HEDIS gaps using existing medical records Health plans and RBEs possess vast volumes of medical records yet are often unable to fully leverage them to improve Quality performance. Reviewing every chart is cost-prohibitive, even with AI-enabled solutions, which are typically priced per chart reviewed, rather than outcomes achieved, and still require 100% clinical abstractor validation. As a result, organizations face significant financial risk without guaranteed Quality improvement, making it difficult to secure budget and demonstrate measurable return on investment. Additionally, year-round HEDIS abstraction has historically been narrow and targeted, limiting the ability to identify broader gap closure opportunities. These challenges come at a critical time, as the National Committee for Quality Assurance (NCQA) continues its transition away from hybrid measures by 2029, increasing the importance of accurate, compliant data capture. Advantmed's Pay for Quality model directly addresses these challenges by aligning cost with outcomes. Clients only pay when Advantmed identifies a compliant numerator or exclusion, eliminating upfront financial risk while ensuring measurable Quality impact. "Our Pay for Quality offering fundamentally changes how health plans approach HEDIS abstraction," said Matt Lambert, CMO & Head of Product Strategy, at Advantmed. "Instead of paying by the chart, plans can now pay only when meaningful, compliant gap closure is achieved. This ensures a clear, outcome-driven return on investment while strengthening overall Quality performance." Powered by Advantmed's proprietary AI-assisted workflow and validated through a rigorous, multi-stage clinical review process, the solution delivers accurate, compliant abstraction aligned with CMS and NCQA specifications. The offering supports a wide range of Medicare Advantage Star measures and provides flexible options, allowing clients to leverage existing medical records, submit targeted gap closure lists, or utilize Advantmed's retrieval services. Advantmed also enhances transparency and operational efficiency by providing hyperlinked medical records with highlighted clinical values, flexible data exports, and integrated collaboration tools. Rapid turnaround for Primary Source Verification (PSV) ensures health plans can meet submission timelines and maximize Quality performance. By shifting the abstraction model from volume-based pricing to outcome-based pricing, Advantmed enables health plans to reduce administrative burden, eliminate financial uncertainty, and accelerate measurable improvements in HEDIS performance and Star Ratings. About Advantmed Founded in 2005, Advantmed is an industry-leading provider of medical record retrieval, medical record review, and health assessment solutions for health plans and providers. Through a tailored, cost-effective suite of services addressing risk adjustment and quality needs, Advantmed helps organizations improve healthcare outcomes and overall performance. 401.309.4848 KEYWORD: CALIFORNIA UNITED STATES NORTH AMERICA INDUSTRY KEYWORD: TECHNOLOGY INSURANCE HEALTH TECHNOLOGY PROFESSIONAL SERVICES HEALTH INSURANCE SOFTWARE DATA ANALYTICS HEALTH DATA MANAGEMENT ARTIFICIAL INTELLIGENCE PUB: 03/05/2026 08:57 AM/DISC: 03/05/2026 08:57 AM
Advantmed, a risk adjustment and quality services provider for health plans, has appointed Dr Matt Lambert as Chief Medical Officer and Head of Product Strategy. He brings over 20 years of clinical experience and executive leadership in healthcare technology and value-based care. Dr Lambert will lead clinical strategy and product development, with immediate focus on enhancing Advantmed's In-Home Assessment programme to improve member engagement and close chronic condition gaps. He will also oversee enhancements to pre-visit clinical review processes and technology infrastructure. Previously, Dr Lambert served as Chief Medical Officer at Curation Health, HealthNXt, and Socially Determined. He also held leadership positions at NEOM, University of Washington, and New York City Health and Hospitals. Founded in 2005, Advantmed provides medical record retrieval, review and health assessment solutions.