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

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

Clover is a Medicare Advantage plan working to develop deeper insights to drive better outcomes for our members through our integrated technology platform. We rely on our abilities to integrate standard health plan data (eligibility, provider network, claims, authorizations, etc.) with clinical information from provider health information systems.

The Senior Associate of Clinical Quality Programs is responsible for the development and execution of the key Stars Programs and will report to the Director of Stars, Clinical Quality Improvement. In this role, you will be the subject matter expert on all things stars related, analyze data to identify areas for improvement and work closely with external partners associated with CMS required Stars activities with entities such as CAHPS, HOS survey vendors, and Medication Adherence vendors. You will develop operational interventions and work cross functionally with teams such as Clinical Operations, Data Science, Provider Relations, Health IT, and Product.

As a Senior Associate of Clinical Quality Programs, you will:

  • Support planning, development, implementation and oversight of delivery of all Stars related business functions.
  • Support design, creation and execution of Stars and Clinical Quality Improvement Measure projects from inception to completion.
  • Oversee clinical program analytics and tooling development including dashboards, etc. 
  • Guide the development and day to day operations of the clinical operations team and the execution of key STAR measure and Quality Improvement initiatives on an ongoing basis.
  • Use data and analytical insights to assist in defining critical KPIs and build core operating dashboards to manage performance related to the stars program.
  • Work with operational leaders within the business to provide recommendations on opportunities for continuous value and process improvement.
  • Drive alignment across functional area leaders to ensure business operations are optimized for stars.
  • Present relevant strategies with analytical evidence and results to the executive leadership team

You will love this job if:

  • You are analytical, enjoy problem solving and have a high level of attention to detail.
  • You are great at prioritizing and executing multiple tasks that adhere to strict deadlines in a fast-paced, evolving environment.
  • You are a motivated self-starter who is comfortable working both independently and as a member of a cross-functional team.
  • You are an effective speaker communicating data findings to cross functional teams and leadership.

You should get in touch if:

  • You have experience working in a managed care environment, preferably Medicare Advantage. 
  • You have experience with clinical data analytics, clinical ontologies and terminologies, such as ICD-10, CPT, LOINC, RxNorm, etc.
  • You have advanced SQL, excel and dashboard experience.
  • You have knowledge of and experience with electronic medical record systems.
  • You have knowledge of clinical program processes (ambulatory and/or acute care) and the data produced by them.
  • You have start-up experience in an entrepreneurial setting, preferred but not required.

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.