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Clover Health · 19 hours ago

Director, HEDIS Operations

United States

Full-time

Remote

Senior Level, Lead/Staff

$176K/yr - $200K/yr

10+ years exp

Clover Health is dedicated to improving the lives of seniors through high-quality, data-driven physician enablement technology. As the Director of HEDIS Operations, you will oversee the HEDIS abstraction processes, ensuring the organization maintains its industry-leading performance while collaborating with various teams to operationalize HEDIS results.

Health CareHealth InsuranceHospitalMedical

Responsibilities

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

Qualification

HEDIS abstraction processesNCQA specificationsCMS Stars methodologyAudit practicesTeam managementOutcomes-driven environmentCross-functional collaboration

Required

10+ years of experience leading HEDIS or Stars operations for a Medicare Advantage plan or vendor

Deep expertise in HEDIS abstraction processes, NCQA specifications, CMS Stars methodology, and audit practices

Successfully managed hybrid and prospective review models at scale

Known for achieving high HEDIS and Stars performance and can point to direct impact on outcomes

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.

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