Hybrid Manager, Clinical Quality & Coding (NP/PA)

Elevance Health; Wallingford (CT); Hybrid; USD 120,000 - 180,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical benefits

Dental benefits

Vision benefits

Short and long-term disability

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

Elevance Health is seeking a Manager of Clinical Performance & Quality Coding to lead risk adjustment and quality documentation across provider encounters. The role requires NP or PA licensure and a master’s degree, with 3+ years in Medicare HCC environments.

Hybrid schedule with in-office/remote balance to foster collaboration and accountability. You will develop training, align clinical workflows, and drive KPI-based performance while mentoring staff and ensuring high-quality chart reviews and

Qualifications

• Requires a current, active NP or PA license from the state of residence.
• Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience applying diagnosis in Medicare HCC models.
• Experience with CMS Risk Models is required.

Responsibilities

• Act as SME on CMS Risk Adjustment and quality documentation.
• Develop and deliver training on advanced coding and documentation with coder feedback.
• Align goals/workflows with clinical leadership to support value capture and high-quality documentation.
• Develop KPI-driven performance management plans for coding timeliness and accuracy.
• Lead clinical quality reviews and chart audits to ensure compliance and remediation where needed.
• Create workflows to close HEDIS care opportunities and support health plan success.
• Oversee hiring, training, coaching, and performance reviews of staff.

Skills

CMS Risk Models

Management experience

HEDIS experience

CDEO/CDEI experience

Education

MSN in Nursing or PA degree

NP/PA license (state)

Tools

CRC certification (preferred)

Job description

Elevance Health is seeking a Manager of Clinical Performance & Quality Coding to lead risk adjustment and quality documentation across provider encounters. The role requires NP or PA licensure and a master’s degree, with 3+ years in Medicare HCC environments.

Hybrid schedule with in-office/remote balance to foster collaboration and accountability. You will develop training, align clinical workflows, and drive KPI-based performance while mentoring staff and ensuring high-quality chart reviews and