Senior Manager, Strategic Configuration

🕒 Maio 16

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $129.000 - $168.000 / ano

⏰ Tempo Integral

🟠 Sênior

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Clover Health

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

A Clover Health (Nasdaq: CLOV) é uma empresa de capacitação de médicos focada em idosos que historicamente tiveram dificuldade de acesso a um sistema de saúde de alta qualidade e a preços acessíveis. Nosso objetivo é oferecer um atendimento excelente, de forma sustentável, com um modelo de negócios voltado para melhorar os resultados médicos, reduzindo custos evitáveis. Fazemos isso adotando uma abordagem holística para entender as necessidades de saúde e os fatores de risco social dos que estão sob nosso cuidado. Essa estratégia é sustentada pela nossa plataforma de software proprietária, o Clover Assistant, projetada para agregar dados de pacientes de todo o ecossistema de saúde para apoiar a tomada de decisões clínicas, apresentando aos médicos e outros prestadores recomendações personalizadas em tempo real no ponto de atendimento. Tornar o atendimento mais acessível está no coração do nosso negócio, e acreditamos que os pacientes devem ter a liberdade de escolher seus médicos. Oferecemos planos acessíveis do Medicare Advantage com amplos benefícios, fornecemos aos médicos de atenção primária o Clover Assistant e também disponibilizamos um atendimento abrangente em casa através do programa Clover Home Care. Com a nossa sede corporativa em Nashville, a força de trabalho da Clover está distribuída por todo os EUA e também inclui uma equipe de tecnólogos de classe mundial sediada em Hong Kong. Gerenciamos o cuidado para membros do Medicare Advantage no Alabama, Arizona, Geórgia, Mississippi, Nova Jersey, Pensilvânia, Carolina do Sul, Tennessee e Texas. Estamos contratando engenheiros de software, cientistas de dados, designers e profissionais de produto que possam nos ajudar a entender o bem-estar dos nossos membros e mantê-los longe de quaisquer riscos de saúde no futuro. Se você é uma pessoa apaixonada e interessada em mudar o sistema de saúde para melhor, então a Clover Health pode ser o lugar certo para você.

Descrição

• First-Pass Accuracy Architecture: Lead the technical design and implementation of strategic configuration logic to ensure flawless first-pass adjudication. Ensure that complex member benefits and provider contract terms are perfectly synchronized with our accuracy goals. • Strategic Process Optimization: Identify and address configuration gaps by optimizing edit logic and implementing enhanced precision-based review triggers to ensure payment precision at the point of initial intake. • Evolution of Automated Solutions: Lead the integration of automated solutions to improve efficiency and accuracy in plan configuration. Utilize data-forward strategies to analyze configuration data, identify trends, and proactively mitigate payment inaccuracies. • Cross-Functional Synergy: Act as the primary strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance. Ensure that plan designs and regulatory requirements are translated into actionable, high-precision configuration logic. • Lean Team Leadership: Provide hands-on, "player-coach" leadership for a small, high-impact team of specialists, fostering a culture of excellence, accountability, and continuous technical learning. • Technical Documentation: Develop best practices and documentation for advanced configuration procedures.

🎯 Requisitos

• You have 7+ years of experience in Medicare Advantage or healthcare plan configuration, with at least 3 years in a leadership or managerial role. • You possess "in the weeds" expertise in technical configuration, specifically regarding complex provider contracts, clinical edits, and general reimbursement logic. • You are highly proficient in health plan systems such as HealthEdge HRP and Source. • You demonstrate strong project management and problem-solving abilities with a proven track record of driving systemic process improvements. • You are passionate about leveraging technology and data-driven insights to drive operational precision. • You have excellent verbal and written communication skills with the ability to translate complex technical concepts for diverse stakeholders.

🏖️ Benefícios

• 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. • Additional Perks: 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!