Clover is reinventing health insurance by working to keep people healthier.
Our clinical programs are designed to improve care & outcomes for our most medically complex members. Clover wants to take accountability for these members' healthcare journeys & provide high-quality personalized care that is consistent with members' values & preferences. Our clinical programs include the Clover In-Home Primary Care Program, Clover Care Visit Program, Readmission Prevention Program, Behavioral Health Program, & Telephonic Care Coordination & Management Program.
We are looking to hire a Director of Clinical Compliance to ensure compliance of our clinical programs with relevant federal, state, & local regulations for provider groups. Under the direction of the Chief Scientific Officer & Associate Chief Medical Officer, you will assume primary responsibility for overseeing the clinical compliance of Clovers clinical programs, which have grown greatly in size & reach in tandem with Clovers growth across multiple geographies in the United States, as well as entry into the CMS/CMMI Direct Contracting program. These programs may be delivered by Clover-employed staff or by third-party organizations.
As the Director of Clinical Compliance you will:
- Set a long-term vision for the Clinical Compliance program, including how it will scale effectively as we rapidly grow our clinical service lines throughout the United States.
- Build out cross-functional compliance efforts in collaboration with our Legal, Privacy, Security, Clinical operations, & Clinical teams. This will include design & implementation of standardized company policies, control systems, training programs, reporting channels & record keeping systems, as well as performance of internal audits with regard to executing compliant clinical protocols.
- Act as the organizational subject matter expert in provider-related regulatory clinical compliance, & work closely with compliance teams specializing in health plan compliance.
- Lead any internal investigations specific to clinical protocols, as needed, & advise on appropriate mitigation & remediation strategies
- Work across teams to identify gaps & develop systems to address any inconsistencies in practice.
- Serve as key liaison with regulatory authorities at state & federal levels that oversee clinical care provision of provider groups.
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 have a collaborative mindset & a positive leadership style.
- Integrity & ethical decision-making is important to you.
You should get in touch if:
- You have 10+ years of relevant experience in clinical compliance, with 5+ years overseeing key aspects of a provider-based healthcare clinical compliance program.
- You have experience monitoring Medicare requirements for patient care delivery & a strong knowledge of federal & state regulatory guidelines & standards related to clinical care provision & documentation.
- You have experience driving clinical programs & initiatives across teams & geographies.
- You are skilled at facilitating better organizational understanding of complex regulatory standards.
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.