Senior Director, HEDIS Operations

October 9

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

• Lead and oversee Clover Health’s HEDIS abstraction and submission processes, ensuring timely and accurate execution. • Manage a team of abstraction experts • Partner with analytics and technical teams to ensure data quality supports numerator capture, exclusions, and supplemental data submission. • Serve as the company’s subject matter expert for HEDIS specifications, auditor engagement, and measure interpretation. • Develop and refine processes to maximize numerator hits, manage exclusions, and ensure correct denominator definitions for all measures. • Ensure operational readiness for HEDIS audits, including preparation, submission accuracy, and remediation processes. • Collaborate cross-functionally with clinical and operational leaders to close gaps and translate abstraction into improved Stars performance. • Drive daily accountability to outcomes, ensuring abstracted results translate into measurable gains in HEDIS and Stars.

🎯 Requirements

• You have 10+ years of experience leading HEDIS or Stars operations for a Medicare Advantage plan or vendor. • You have deep expertise in HEDIS abstraction processes, NCQA specifications, CMS Stars methodology, and audit practices. • You have successfully managed hybrid and prospective review models at scale. • You are known for achieving high HEDIS and Stars performance and can point to direct impact on outcomes. • You thrive in high-stakes, outcomes-driven environments and can step in quickly to deliver results.

🏖️ 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. • 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!