Director, HEDIS Business Operations

Director, HEDIS Business Operations

At Clover Health, we are dedicated to improving the lives of seniors through high-quality, data-driven physician enablement technology. Initially scaled within our own Medicare Advantage provider network, we have built an innovative technology platform, designed to put actionable clinical insights into the hands of physicians at the point of care.

In 2024, Clover's PPO plan achieved an industry leading 4.94 stars in HEDIS, with significant impact driven by its innovative technology - Counterpart Assistant. Read more about how CA drove this improvement in our case study here.

As the Director of HEDIS Business Operations, you will serve as the connector across Clover's clinical, analytic, and operational teams to deliver measurable HEDIS impact. You will design and manage the programs, ranging from incentives to member engagement, that directly drive numerator closure, while partnering with HEDIS Operations to ensure seamless alignment from program design through abstraction, audit, and submission. Ultimately, you will design programs to ensure members of Clover's Medicare Advantage plan are always provided with the industry's leading clinical quality.

As a Director, HEDIS Business Operations you will :

• 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.

Success in this role looks like :

You should get in touch if :

Benefits Overview :

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About Counterpart Health : In 2018, Clover Health set out to do something unprecedented : build a clinically intuitive, AI-enabled solution that fits within physicians' workflows to help support the earlier diagnosis and management of chronic conditions.

Years later, that vision is a reality, with thousands of practitioners using Counterpart Assistant during patient visits to improve disease management, reduce medical expenses, and drive success in value-based care.

With an exceptional team of value-based care and technology experts, Counterpart Health is driving value-based care at the speed of software.

Counterpart Health is a subsidiary of Clover Health. 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, perspectives, opinions, 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.

A reasonable estimate of the base salary range for this role is $176,000 to $200,000. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant's education, work experience, certifications, etc.