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Clover Health // data driven health insurance
United States    Posted: Thursday, July 08, 2021
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Clover is reinventing health insurance by working to keep people healthier.

Stars operations are a critical barometer of the company's health, indicating how well we're helping our members achieve better health outcomes & how well we're functioning as a business. Medicare Star ratings also have a significant impact on the company's revenue & ability to offer better insurance benefits & higher touch care.

We are looking to hire a Director, Stars to lead our Stars operations team. In this role you will partner with operational leadership in identifying opportunities to leverage technology & teams to improve processes & operations. This role includes creating connectivity between teams, data & business analytics outcomes & cross-functional solutions to deliver on strategies & goals. You will be accountable for the end to end management of Stars operations to ensure informed & financially viable decisions are made. You will also engage with business partners for an integrated approach in planning, implementing & managing Stars operations to achieve & maintain our Stars goals. 

As a Director, Stars you will:

  • Lead efforts to increase & maximize the Medicare Star ratings by developing short & long-term strategies, goals & objectives (with measurable outcomes) across applicable departments.
  • Provide management with overall status reports related to month-over-month & year-over-year Stars performance, including any issues that may impact the organization.
  • Collaborate across the organization to guide greater financial & operational efficiency & decision-making. 
  • Build, lead & manage a team focused on delivering upon CMS requirements & modern business processes & capabilities for the organization; build sustainability for future growth.
  • Promote a culture of high performance, compliance, & continuous process improvement that values innovation & commitment to Clover Healths success; monitor CMS requirements related to Stars.
  • Manage business planning, budget, business continuity, risk management & operating model.
  • Partner with technology to prioritize business & regulatory needs for Stars.
  • Enhance Stars OKR benchmarking program & ensure results are incorporated into business improvement programs.
  • Design, implement & manage the vendor management program for Stars Operations to increase efficiencies, effectiveness, oversight, compliance & overall visibility.
  • Mentor, coach & counsel team members.

You will love this job if:

  • You are highly organized & logistically-minded. You dont shy away from complex problems.
  • You are a strategic prioritizer, & able to identify where & when to focus your energy.
  • You are systematic & logical. You believe in the value of making data-driven decisions & you continuously monitor the efficacy of your programs through metrics tracking.
  • You are agile & comfortable working in a constantly evolving environment. You embrace ambiguity & speed while maintaining a bias towards action.

You should get in touch if:

  • You have a strategic understanding of Medicare Advantage plans along with 7+ years successful business leadership experience in managed care with a focus on Stars.
  • You are able to design & develop successful operating models & you have strong vendor management & oversight experience.
  • You have clear experience leading & driving fixes & regulatory changes with operations & technical partners.
  • You are capable of big-picture visualization, critical thinking & sequencing (i.e., the ability to envision the product of complex business goals & work backwards to ensure all of the requisite steps & details are covered for successful achievement).

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.


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