Senior Manager, Quality Improvement

Clover Health•Jersey City, NJ

22d•$140,000 - $171,000•Remote

About The Position

At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most. This role requires an experienced Registered Nurse (RN) with strong knowledge of regulatory requirements, QI methodology, and Medicare Advantage program compliance. You will partner cross-functionally with internal and external stakeholders to strengthen Clover’s QI Program, ensuring compliance, operational excellence, and continuous improvement in care delivery.

Requirements

Active, unrestricted RN license (required).
Bachelor’s degree in Nursing or a related field (Master’s preferred).
Minimum 3 years of experience in Medicare Advantage or similar managed care setting.
Deep knowledge of CMS MMCM Chapter 4 (Benefits & Beneficiary Protections) and Chapter 5 (Quality Improvement Program) requirements.
Experience in regulatory compliance, QI program oversight, and audit readiness.
At least 3 years of leadership experience, including direct team management.
Strong skills in data analysis, performance monitoring, and process improvement.
Proficiency with Microsoft Office and Google Suite.
Excellent written and verbal communication skills; ability to present to executive leadership and committees.

Responsibilities

Oversee Regulatory QI Program Elements
Lead development and maintenance of the Annual Quality Improvement Program Description and Annual QI Work Plan in compliance with CMS MMCM Chapters 4 and 5.
Ensure timely completion of annual QI Program Evaluation, incorporating performance results and regulatory updates.
Manage QI Committee activities, ensuring documentation, reporting, and escalation of findings to governance bodies.
Regulatory Compliance & Audit Readiness
Ensure CMS, NCQA, and state QI requirements are met and documented.
Maintain audit readiness for CMS Program Audits and state/federal reviews.
Partner with Legal and Compliance teams to interpret new regulations and implement operational changes.
Quality of Care Oversight
Oversee Quality of Care (QOC) investigations, including case review, root cause analysis, and corrective action planning.
Collaborate with Medical Directors and clinical teams on QOC determinations and improvement strategies.
Performance Monitoring & Improvement
Support Star Ratings strategy by evaluating performance data and identifying barriers to improvement.
Present QI outcomes, trends, and opportunities to senior leadership and regulatory committees.
Implement cross-functional improvement initiatives using rapid-cycle QI methodology.
Leadership & Collaboration
Supervise a team of QI professionals, providing coaching and professional development.
Lead cross-departmental working groups to drive execution of the QI Work Plan.
Foster a culture of quality, compliance, and continuous improvement across the organization.

Benefits

Financial Well-Being : Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
Physical Well-Being : We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
Mental Well-Being : We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
Professional Development : Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
Reimbursement for office setup expenses
Monthly cell phone & internet stipend
Remote-first culture, enabling collaboration with global teams
Paid parental leave for all new parents
And much more!