Clover Health-posted 3 months ago
$176,000 - $200,000/Yr
Full-time • Director
501-1,000 employees

At Clover Health, we are dedicated to improving the lives of seniors through high-quality, data-driven physician enablement technology. Initially scaled within our own Medicare Advantage provider network, we have built an innovative technology platform, designed to put actionable clinical insights into the hands of physicians at the point of care. As the Director of HEDIS Business Operations, you will serve as the connector across Clover’s clinical, analytic, and operational teams to deliver measurable HEDIS impact. You will design and manage the programs, ranging from incentives to member engagement, that directly drive numerator closure, while partnering with HEDIS Operations to ensure seamless alignment from program design through abstraction, audit, and submission. Ultimately, you will design programs to ensure members of Clover’s Medicare Advantage plan are always provided with the industry’s leading clinical quality.

  • Lead the business strategy and execution for HEDIS outcomes, focusing on programs that ultimately yield success in closing care gaps for members across the various interaction channels available.
  • Establish and manage incentive structures and provider engagement models that directly drive numerator closure.
  • Develop and oversee cross-functional initiatives that translate measure logic into actionable programs across the organization.
  • Partner with HEDIS Operations to ensure business programs align with abstraction and submission workflows, creating a seamless end-to-end process.
  • Own scenario-planning for HEDIS measure cutpoints and Stars implications, guiding the organization toward the interventions that will drive results.
  • Anticipate and prepare for measure evolution, ensuring Clover is strategically positioned for future changes and always ahead of the industry changes.
  • Track and communicate performance outcomes, highlighting risks, opportunities, and ROI of interventions to senior leadership.
  • 7+ years of experience in healthcare program management and strategy.
  • Experience leading cross-functional programs that align multiple stakeholders toward a common outcome.
  • Highly analytical, able to interpret performance data and translate it into effective interventions.
  • Understanding of the HEDIS and Stars landscape and motivation by the business and programmatic levers that deliver results.
  • Ability to thrive in a dynamic, high-stakes environment where success is measured in outcomes, not activity.
  • Competitive base salary and equity opportunities.
  • Performance-based bonus program.
  • 401k matching.
  • Comprehensive medical, dental, and vision coverage.
  • Mental health resources and flexible time-off policy.
  • Learning programs, mentorship, and professional development funding.
  • Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities.
  • Reimbursement for office setup expenses.
  • Monthly cell phone & internet stipend.
  • Remote-first culture.
  • Paid parental leave for all new parents.
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