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Clover Health

Clover Health is a unique health insurance plan focused on driving down costs and producing improved health outcomes.

Senior Associate, Stars Pharmacy Operations
Jersey City, NJ, US
San Francisco, CA, US
Job Description / Skills Required

Clover is reinventing health insurance by working to keep people healthier.

The Clinical Programs team is responsible for ensuring patients have access to the right care at the right time, in the right setting. We collaborate with a cross functional group of clinical, operations and technology teams to deliver personalized care to our members.

Clover's Star rating is a critical barometer of the company's health, indicating how well we're helping our members achieve better health outcomes and how well we're functioning as a business. Our Stars rating also has a significant impact on the company's revenue and ability to offer better insurance benefits and higher touch care.

In this role, you'll execute and develop Stars Medication Adherence strategies with Star Leadership in partnership with key internal and external stakeholders. You will develop a tangible operational work plan, calendar of initiatives, dive in to root cause analysis to address and remove barriers to success. The Stars team collaborates with operations, clinical pharmacy, data science and technology to ensure the stars strategy is implemented and executed that will lead to improved performance in Medication Adherence Star Measures and Statin use in persons with Diabetes and Cardiovascular Disease. Through partnerships with key peers, you'll also ensure the organization is increasing performing across Diabetes, Hypertension and Hyperlipidemia medication adherence measures. You will also be responsible for measuring company-wide Stars performance and communicating related progress, challenges, and resourcing needs.

As a Senior Associate for Part D Star Measures you will:


 



  • Collaborate with Head of Stars Strategy on strategic initiatives, establish key performance indicators and establish metric level goals for medication adherence per contract

  • Develop and maintain the Star Ratings work plan for medication adherence

  • Ensure Stars technical guidance from CMS, PQA and internal teams are incorporated into the work plan

  • Take lead on driving day to day operations related to medication adherence

  • Integrate analytics to inform initiatives and reporting

  • Enjoy working with Excel and have experience building out operational models to drive insight and decision

  • Conduct evaluations of initiative effectiveness on impacting Star Rating performance over time

  • Identify and prioritize actions needed to improve performance

  • Collaborate internally to ensure medication adherence measures achieve established metric goals per contract

  • Report performance to plan leaders, and escalate issues and barriers to leadership


 


You will love this job if:


 



  • You want to make an impact. You thrive off of helping others and want your work to make a difference in our members' lives, while also advocating for their needs.

  • You are a strong problem-solver, you like to use your analytical skills to come up with solutions to problems

  • You are collaborative and enjoy working cross-functionally in a matrixed environment to accomplish goals together

  • You are highly organized, efficient and demonstrate superior attention to detail

  • You are nimble, and comfortable working in a constantly evolving environment. You embrace ambiguity and speed while maintaining a bias towards action


 


You should get in touch if:


 



  • You have at least 2 years of MAPD Star Ratings experience

  • You have operational expertise in Part D Stars and/or MAPD operations with a proven track record of success

  • You have effective verbal, written, and interpersonal skills

  • You have an understanding of Stars strategy and experience working on related programs

  • You exhibit basic SQL skills or have a desire to learn the SQL language


Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.