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Clover Health · 3 days ago

Director, HEDIS Business Operations

United States

Full-time

Remote

Mid, Senior Level

$176K/yr - $200K/yr

7+ 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 Business Operations, you will connect clinical, analytic, and operational teams to deliver measurable HEDIS impact and design programs that drive care gap closures for members of Clover’s Medicare Advantage plan.

Health CareHealth InsuranceHospitalMedical

Responsibilities

Lead the business strategy and execution for HEDIS outcomes, focusing on programs that ultimately yield success in closing care gaps for members across the various interaction channels available - ranging from provider incentive programs, call center outreach, mailing lab testing kits, to chart chase and abstraction

Establish and manage incentive structures and provider engagement models that directly drive numerator closure

Develop and oversee cross-functional initiatives that translate measure logic into actionable programs across the organization

Partner with HEDIS Operations to ensure business programs align with abstraction and submission workflows, creating a seamless end-to-end process

Own scenario-planning for HEDIS measure cutpoints and Stars implications, guiding the organization toward the interventions that will drive results

Anticipate and prepare for measure evolution (hybrid to admin, admin to digital, display to official), ensuring Clover is strategically positioned for future changes and always ahead of the industry changes

Track and communicate performance outcomes, highlighting risks, opportunities, and ROI of interventions to senior leadership

Qualification

HEDIS knowledgeHealthcare program managementCross-functional leadershipAnalytical skillsStakeholder engagementCommunication skillsAdaptability

Required

7+ years of experience in healthcare program management and strategy

Led cross-functional programs that align multiple stakeholders toward a common outcome

Highly analytical, able to interpret performance data and translate it into effective interventions

Understand the HEDIS and Stars landscape and are motivated by the business and programmatic levers that deliver results

Thrive in a dynamic, high-stakes environment where success is measured in outcomes, not activity

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

And much more!