Clover is reinventing health insurance by working to keep people healthier.
Risk Adjustment 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. Risk Adjustment has a significant impact on the company's revenue & ability to offer better insurance benefits & higher touch care.
We are looking to hire a Director, Risk Adjustment Operations to lead our Risk Adjustment 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 Risk Adjustment Operations, including for our Medicare Advantage & Direct Contracting Entity, to ensure informed & financially viable decisions are made. You will also engage with business partners for an integrated approach in planning, implementing & managing Risk Adjustment Operations for improved outcomes.
As a Director, Risk Adjustment you will:
- Identify & drive implementation of short & long-term strategies, goals & objectives (with measurable outcomes) for Risk Adjustment Operations.
- 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 Risk Adjustment Operations.
- Manage business planning, budget, business continuity, risk management & operating model.
- Partner with technology to prioritize business & regulatory needs for Risk Adjustment operations.
- Enhance Risk Adjustment OKR benchmarking program & ensure results are incorporated into business improvement programs.
- Design, implement & manage the vendor management program for Risk Adjustment 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 comprehension of Medicare Advantage plans along with 7+ years successful business leadership experience in managed care with a focus on Risk Adjustment.
- 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.