Manager Clinical Performance & Quality (Nurse Practitioner/Physician Assistant)
Core
Leading quality documentation and value capture for provider visit medical encounters to ensure accurate diagnosis codes (ICD-10) and support high-quality clinical documentation.
Role type
Manager, Clinical Performance & Quality (Nurse Practitioner/Physician Assistant)
Builds
CMS Risk Adjustment models, HEDIS care opportunities, and clinical quality audit processes
Domain
Healthcare administration, Risk Adjustment, Quality Improvement
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
CMS Risk Models, ICD-10 coding, Medicare HCC Model, clinical documentation review, performance management, KPI tracking, HEDIS workflows
Preferred skills
Management/supervisory experience, HEDIS experience, clinical data integrity (CDEO/CDEI), AAPC CRC certification
Technologies
EMR, CMS Risk Models, ICD-10
Responsibilities
Serve as subject matter expert on CMS Risk Adjustment and quality documentation; Develop and deliver clinical training on advanced coding; Liaise with clinical leadership on workflow alignment; Develop performance management plans and KPIs; Manage clinical quality reviews and chart audits; Develop workflows for closing HEDIS opportunities; Participate in peer review of medical documentation; Hire, train, coach, and evaluate direct reports.
Seniority
Manager, hands-on IC with team leadership
