Manager Clinical & Quality; Nurse Practitioner​/Physician Assistant

Manager Clinical Performance & Quality (Nurse Practitioner/Physician Assistant)

Location
:
Must be in the office 3 times per week. Must be within commuting distance of eligible offices.

Hours
:
General business hours, Monday through Friday (8-5 central).

Hybrid 2:
Associates to be in-office 3 days per week. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Policy Note
:
Candidates not within a reasonable commuting distance cannot be considered unless accommodation is granted as required by law.

• Responsible for leading the quality documentation and value capture for all provider visit medical encounters to ensure application of accurate diagnosis codes (ICD‑10).
• Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality documentation.
• Develops and delivers clinical focused training on advanced coding and documentation while incorporating coder feedback.
• Liaison to the clinical leadership on alignment of goals and workflows to support value capture initiatives and high‑quality clinical documentation.
• Develops a performance management plan, KPI’s and clinical level tracking to meet quarterly goals for coding timeliness, accuracy, and risk adjustment.
• Develops and manages clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score guidelines feedback mechanism and ensures compliance with remediation procedures.
• Develops operational and clinical workflows for closing HEDIS care opportunities to ensure practices and health plan success.
• Participates in peer review of medical documentation for completed visits notes as well as patient profile information in EMR.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

• 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 in applying appropriate diagnosis in the Medicare HCC Mode, or any combination of education and experience providing an equivalent background.
• Experience with CMS Risk Models.

• Previous management/supervisory experience with direct reports.
• HEDIS experience.
• Experience with clinical data/documentation integrity (CDEO or CDEI).
• Preferred AAPC Certified Risk Adjustment Coder (CRC) certification.

Job Level
:
Manager

Workshift
: 1st Shift (United States of America)

Job Family
: MED & Licensed Nurse

We offer a range of market‑competitive total rewards that include merit increases, paid holidays, paid time off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long‑term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.