Clover is reinventing health insurance by working to keep people healthier.
Our clinical operations teams include caring & compassionate professionals dedicated to improving the lives of our most vulnerable patients. These teams include a range of clinicians such as physicians, nurse practitioners, social workers, & medical assistants which provide in-home primary care, transitional care services, annual wellness visits, supplemental supportive care services & behavioral health coordination.
We are greatly expanding our covered lives in markets across the United States through our Medicare & Direct Contracting Entity (DCE). Based on this growth as well as anticipated needs of our patients, we will be expanding our clinical programs through augmentation of our internal clinical teams as well as collaboration with external vendor partners including in-home care providers, home health providers, & hospice providers who will provide clinical services. We are excited to hire a Clinical Operations Manager with a background in implementing population health strategies with providers to support the operational scaling of Clovers DCE.
As a Clinical Operations Manager, you will:
- Build & maintain collaborative working relationships with internal Clover stakeholders (e.g., Clinical Medical Directors, Network, Strategic Finance & Clover product teams).
- Complete an assessment of provider organization capabilities around population health processes, technology infrastructure, clinical leadership & governance.
- Drive the coordination of the value realization process in partnership with key Clover collaborators including: Clinical Medical Directors, Network, Strategic Finance & Clover product teams to identify opportunity areas, establish targets & drive improvement at the provider & patient level in clinical performance metrics (IP, ER, Complex Patients, Preferred Provider utilization, etc.).
- Formalize the approach to medical expense management at a provider organizational level by developing practice level clinical action plans.
- Identify & share best practices on clinical improvement approaches relative to the established clinical action plan.
- Identify & surface to internal stakeholders roadblocks/challenges that hinder performance versus clinical action plan objectives.
- Partner with Clinical Medical Directors to facilitate behavior change at the provider & practice level through the consideration of Clover clinical insights ultimately impacting quality & total cost of care.
- Identify the patient relevant clinical factors that if addressed would support improvement in outcomes.
- Partner with & manage vendors external to Clover to source targeted clinical capabilities to drive complex care & medical expense reduction.
You will love this job if:
- You are passionate about population health management.
- You enjoy working with clinicians in the community to identify & support vulnerable patients.
- You are skilled at collaborating with provider organizations to assess clinical processes & recommend improvements that can alter a patients health trajectory.
- You worked with accountable care organization leadership to influence the adoption of specific population health strategies specific to targeted population outcomes.
- You are data driven & persuasive in your approach.
- Your values are in line with ours & believe that patients deserve the highest quality services & are committed to making it happen.
You should get in touch if:
- You have 5+ years combined experience with improving clinical quality, establishing best practices, healthcare analytics, or driving clinical transformation initiatives with population health programs, Patient Center Medical Homes or in the managed care industry.
- You have 2+ years of experience in interpreting & utilizing claims analysis, clinical data analytics, outcomes measurement in healthcare & use of that data to drive change.
- You have physician practice experience & preferably a nursing background (LPN, RN, etc.).
- You have experience preparing & presenting information to clinical & executive level leadership.
- You have Medicare and/or Commercial ACO experience.
- You have experience using a Plan-Do-Study-Act (PDSA) rapid cycle improvement approach.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest & 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 & analytics to empower our clinical staff to intervene & provide personalized care to the people who need it most.
We always put our members first, & our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate & mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clovers inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer & our employees are people with different strengths, experiences & backgrounds, who share a passion for improving people's lives. Diversity not only includes race & gender identity, but also age, disability status, veteran status, sexual orientation, religion & many other parts of ones identity. All of our employees points of view are key to our success, & inclusion is everyone's responsibility.