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 and 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 and how well we're functioning as a business. Our Stars rating also has a significant impact on the company's revenue and ability to offer better insurance benefits and higher touch care.
In this role, you'll execute and develop Stars Strategy with Star Leadership in partnership with key internal and external stakeholders. You will develop a tangible operational work plan, calendar of initiatives, dive in to root cause analysis to address and remove barriers to success. The Stars team collaborates with operations, data science and technology to ensure the stars strategy is implemented and executed that will lead to improved performance with clinical Stars measures (HEDIS and 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 and communicating related progress, challenges, and resourcing needs.
As a Manager, Stars Strategy you will:
- Collaborate with Head of Stars Strategy on strategic initiatives, key performance indicators and domain drivers
- Develop and maintain the Star Ratings work plan
- Ensure Stars technical guidance from CMS, NCQA, PQA and internal teams are incorporated into the work plan
- Take lead on Stars request for information and collect and consolidate measure owner feedback
- Integrate analytics to inform initiatives and reporting
- Conduct evaluations of initiative effectiveness on impacting Star Rating performance over time
- Identify and prioritize actions needed to improve performance
- Develop and 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, and escalate issues and barriers to leadership
You will love this job if:
- You want to make an impact. You thrive off of helping others and 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 and 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, and comfortable working in a constantly evolving environment. You embrace ambiguity and speed while maintaining a bias towards action
- You are humble and understand that as a manager of people, you are there to serve and 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 and written communication and interpersonal skills
- You have an understanding of Stars strategy and experience working on related programs
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.