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Clover Health · 2 months ago

Senior Manager, Quality Improvement

United States

Full-time

Remote

Mid, Senior Level

$140K/yr - $171K/yr

3+ years exp

Clover Health is committed to providing high-quality healthcare plans for America’s seniors. The Senior Manager, Quality Improvement will oversee regulatory compliance, lead quality improvement initiatives, and manage a team of QI professionals to enhance care delivery and operational excellence.

Health CareHealth InsuranceHospitalMedical

H1B Sponsor Likely

Responsibilities

Oversee Regulatory QI Program Elements

Lead development and maintenance of the Annual Quality Improvement Program Description and Annual QI Work Plan in compliance with CMS MMCM Chapters 4 and 5

Ensure timely completion of annual QI Program Evaluation, incorporating performance results and regulatory updates

Manage QI Committee activities, ensuring documentation, reporting, and escalation of findings to governance bodies

Ensure CMS, NCQA, and state QI requirements are met and documented

Maintain audit readiness for CMS Program Audits and state/federal reviews

Partner with Legal and Compliance teams to interpret new regulations and implement operational changes

Oversee Quality of Care (QOC) investigations, including case review, root cause analysis, and corrective action planning

Collaborate with Medical Directors and clinical teams on QOC determinations and improvement strategies

Support Star Ratings strategy by evaluating performance data and identifying barriers to improvement

Present QI outcomes, trends, and opportunities to senior leadership and regulatory committees

Implement cross-functional improvement initiatives using rapid-cycle QI methodology

Supervise a team of QI professionals, providing coaching and professional development

Lead cross-departmental working groups to drive execution of the QI Work Plan

Foster a culture of quality, compliance, and continuous improvement across the organization

Qualification

Registered Nurse (RN)Medicare Advantage experienceRegulatory complianceQuality Improvement methodologyData analysisPerformance monitoringTeam managementMicrosoft OfficeGoogle SuiteWritten communicationVerbal communication

Required

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

Preferred

Master's degree in Nursing or a related field

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.

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!

Company

Clover Health

Glassdoor3.4

Clover is a healthcare technology company helping members live their healthiest lives with its Medicare Advantage plans.

Founded in 2014

Nashville, Tennessee, USA

501-1000 employees

http://cloverhealth.com

H1B Sponsorship

Clover Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2025 (2)