Anticipated End Date: 2026-07-28 Position Title: Manager Clinical Performance & Quality (Nurse Practitioner/Physician Assistant) Responsibilities Lead quality documentation and value capture for all provider visit medical encounters, ensuring accurate diagnosis coding (ICD-10). Serve as the primary resource and subject matter expert on CMS Risk Adjustment and quality documentation. Develop and deliver clinical-focused training on advanced coding and documentation, incorporating coder feedback. Liaison to clinical leadership to align goals and workflows supporting value capture initiatives and high-quality clinical documentation. Develop performance management plans, KPIs, and clinical-level tracking to meet quarterly goals for coding timeliness, accuracy, and risk adjustment. Manage clinical quality reviews to ensure peer review and chart audit processes, including targeting chart reviews, audit percentages, score guidelines, feedback mechanisms, and compliance with remediation procedures. Develop operational and clinical workflows to close HEDIS care opportunities, ensuring practice and health plan success. Participate in peer review of medical documentation for completed visit notes and patient profile information in EMR. Hire, train, coach, counsel, and evaluate performance of direct reports. Required Qualifications Current, active, valid, and unrestricted nurse practitioner (NP) or PA license in applicable state(s). Master's in Nursing (or PA equivalent) and at least 3 years of clinical experience applying appropriate diagnoses in the Medicare HCC model, or equivalent education/experience. Experience with CMS Risk Models. Preferred Qualifications Prior management/supervisory experience with direct reports. HEDIS experience. Experience with clinical data/documentation integrity (CDEO or CDEI). APA Certified Risk Adjustment Coder (CRC) certification. Job Details Job Level: Manager Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse Location: Must be within commuting distance to eligible office; in‑office 3 days per week. Hours: General business hours, Monday through Friday (8‑5 Central). Hybrid 2 model with 3 days in‑office per week while allowing virtual work flexibility. Anticipated End Date: 2026-07-28 Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. #J-18808-Ljbffr
Manager Clinical Performance & Quality (Nurse Practitioner/Physician Assistant) • Mason, OH, United States
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