Clover is reinventing health insurance by working to keep people healthier.
The Clinical Programs team is responsible for ensuring patients have access to the right care at the right time, in the right setting. We collaborate with a cross functional group of clinical, operations & technology teams to deliver personalized care to our members.
Clover's Star rating is 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. Our Stars rating also has a significant impact on the company's revenue & ability to offer better insurance benefits & higher touch care.
In this role, you'll execute & develop Stars Strategy with Star Leadership in partnership with key internal & external stakeholders. You will develop a tangible operational work plan, calendar of initiatives, dive in to root cause analysis to address & remove barriers to success. The Stars team collaborates with operations, data science & technology to ensure the stars strategy is implemented & executed that will lead to improved performance with clinical Stars measures (HEDIS & Part D). Through partnerships with key peers, you'll also ensure the organization is increasing performing across CAHPS, HOS, HEDIS, Part D, Administrative domains. You will also be responsible for measuring company-wide Stars performance & communicating related progress, challenges, & resourcing needs.
As a Manager, Stars Strategy you will:
- Collaborate with Head of Stars Strategy on strategic initiatives, key performance indicators & domain drivers
- Develop & maintain the Star Ratings work plan
- Ensure Stars technical guidance from CMS, NCQA, PQA & internal teams are incorporated into the work plan
- Take lead on Stars request for information & collect & consolidate measure owner feedback
- Integrate analytics to inform initiatives & reporting
- Conduct evaluations of initiative effectiveness on impacting Star Rating performance over time
- Identify & prioritize actions needed to improve performance
- Develop & implement with accountable teams to improve measure level performances
- Collaborate with accountable teams toward progression on the Star Rating work plan
- Report performance to plan leaders, & escalate issues & barriers to leadership
You will love this job if:
- You want to make an impact. You thrive off of helping others & want your work to make a difference in our members' lives, while also advocating for their needs.
- You are a strong problem-solver, you like to use your analytical skills to come up with solutions to problems
- You are collaborative & enjoy working cross-functionally in a matrixed environment to accomplish goals together
- You are extremely organized and never let things fall through the cracks
- You are nimble, & comfortable working in a constantly evolving environment. You embrace ambiguity & speed while maintaining a bias towards action
- You are humble & understand that as a manager of people, you are there to serve & support others while working together
You should get in touch if:
- You have at least 3-5 years of MAPD Star Ratings experience
- You have strong operational expertise in HEDIS, Part D Stars, CAHPS/HOS and/or MAPD operations with a proven track record of success
- You have strong verbal & written communication & interpersonal skills
- You have an understanding of Stars strategy & experience working on related programs
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.