Senior Manager, Quality Improvement

November 7

Apply Now

Receive Emails with Similar Jobs

Clover Health

WebsiteLinkedInAll Job Openings

Clover Health (Nasdaq: CLOV) is a physician enablement company focused on seniors who have historically lacked access to affordable, high-quality healthcareWe aim to provide great care, in a sustainable way, by having a business model built around improving medical outcomes while lowering avoidable costs. We do this while taking a holistic approach to understanding the health needs and social risk factors of those under our care. This strategy is underpinned by our proprietary software platform, the Clover Assistant, which is designed to aggregate patient data from across the health ecosystem to support clinical decision-making by presenting physicians and other providers with real-time, personalized recommendations at the point of care.Making care more accessible is at the heart of our business, and we believe patients should have the freedom to choose their doctors. We offer affordable Medicare Advantage plans with extensive benefits, provide primary care physicians with the Clover Assistant, and also make comprehensive home-based care available via the Clover Home Care program.With our corporate headquarters in Nashville, Clover’s workforce is distributed around the U.S. and also includes a team of world-class technologists based in Hong Kong. We manage care for Medicare Advantage members in Alabama, Arizona, Georgia, Mississippi, New Jersey, Pennsylvania, South Carolina, Tennessee, and Texas.We are hiring software engineers, data scientists, designers and product folks who can help us understand our members’ wellness and steer them clear of any health risks down the road.If you’re a passionate person and interested in changing healthcare for the better, then Clover Health may just be the place for you.

501 - 1000 employees

📋 Description

• Oversee Regulatory QI Program Elements: lead development and maintenance of the Annual Quality Improvement Program Description and Annual QI Work Plan, ensure timely completion of annual QI Program Evaluation, manage QI Committee activities. • Regulatory Compliance & Audit Readiness: ensure CMS, NCQA, and state QI requirements are met, maintain audit readiness for CMS Program Audits, partner with Legal and Compliance teams. • Quality of Care Oversight: oversee Quality of Care investigations, collaborate with Medical Directors and clinical teams. • Performance Monitoring & Improvement: support Star Ratings strategy, present QI outcomes, implement cross-functional improvement initiatives. • Leadership & Collaboration: supervise QI professionals, lead cross-departmental working groups, foster a culture of quality, compliance, and continuous improvement.

🎯 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.

🏖️ Benefits

• Financial Well-Being: competitive base salary and equity opportunities, performance-based bonus program, 401k matching, regular compensation reviews. • Physical Well-Being: comprehensive medical, dental, and vision coverage. • Mental Well-Being: initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, generous flexible time-off policy, remote-first culture supporting collaboration. • Professional Development: learning programs, mentorship, professional development funding, regular performance feedback and reviews. • Additional Perks: Employee Stock Purchase Plan (ESPP), reimbursement for office setup expenses, monthly cell phone & internet stipend, paid parental leave for all new parents.