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Clover Health

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

Director, Clinical Programs
Remote
United States of America
Job Description / Skills Required

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

Our clinical and clinical operations teams include caring and passionate professionals dedicated to improving the lives of our most vulnerable members. These teams include a range of clinicians such as physicians, nurse practitioners, nurses, social workers, and medical assistants who provide in-home primary care, transitional care services, annual wellness visits, supportive care services, and behavioral health coordination.

Clover is greatly expanding its covered lives in markets across the United States through its Medicare Advantage and Direct Contracting entities. Based on this expansion as well as the anticipated needs of its members, Clover will be expanding its clinical programs through expansion of its internal clinical teams as well as collaboration with external vendor partners including in-home care providers, home health providers, and hospice providers who will provide clinical services. We are looking for an experienced Operations Senior Manager with extensive health care experience to support operational scaling via these external complex care (CCM) partners to drive great outcomes for Clover’s most vulnerable members.

As a Director, Clinical Programs you will:

  • Closely partner with our Chief Scientific Officer, SVP of Clinical Operations, and Complex Care (CCM) Medical Directors to ensure successful execution of our CCM expansion strategy. 
  • Ensure that appropriate member identification for CCM partners, including in-home primary care, home health care, and hospice, is occurring via internal Clover teams as well as CCM partners. This will require oversight of regular data transfers, ingestion, and analysis involving cross functional teams at Clover. 
  • Ensure that lists of members identified for CCM programs is being shared to CCM partners in an integrated manner both manually and via our technology platform, the Clover Assistant (CA).
  • Provide oversight of CCM partners’ outreach to patients to make sure it is timely, effective, and occurring in a coordinated way with Clover teams (e.g. member navigators) and DCE participant providers. Coordination will likely entail close work with our internal technology team and the CCM partners themselves.
  • Ensure that CCM partners are maintaining high levels of engagement with high risk beneficiaries enrolled in their programs. 
  • Ensure that Clover teams, including product teams responsible for internal tools are supporting the effectiveness of the referral process and the care delivered by CCM partners, including through the use of metrics and dashboarding available to both partners and internal Clover teams.
  • Ensure that clinical operations necessary for clinical outcomes improvement/MedEx reduction are occurring at the partner level.
  • Stimulate in-market coordination among CCM partners, such as by referrals amongst each other to drive high value.
  • Provide help with recruiting/staffing of clinical teams.

You will love this job if:

  • You are someone who is excited to build processes that are effective and scalable.
  • You are passionate about leading the charge of scaling our complex care clinical business and service operation.
  • Your values are in line with ours and believe that patients deserve the highest quality services and are committed to making that happen.
  • You are dedicated to training and mentoring team members from cross functional environments.
  • You have integrity and will adhere to the high ethical standards set for by the organization.
  • You are diligent, detail-oriented, and mission-driven with a knack for critical problem-solving.

You should get in touch if:

  • You have a minimum of five years of direct supervisory or management experience in healthcare / patient care services. Experience running outpatient value-based practices preferred.
  • You have proven experience maintaining effective working relationships with operations, clinical, technology, and executive staff members.
  • You have experience in administrative oversight of clinical staff adherence to program policies and procedures. Health plan experience managing the performance of contracted value based practice preferred.
  • You have a strong commitment to customer service and excellence in healthcare.
  • You have the ability to establish long-range objectives and specify the strategies and actions required to achieve them.
  • You are highly collaborative with the ability to work with corporate colleagues, clinical leadership and clinical staff to develop cost-effective systems of care and promote appropriate utilization.
  • You have demonstrated the ability to provide leadership and influence others to achieve improvements in quality and operational efficiency across a complex clinical environment.
  • You are able to foster effective working relationships and build consensus, and successfully mediate and resolve complex problems and issues.

 

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.


About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.