Director, Internal Monitoring at Clover Health
United States of America

Clover's Operations teams are responsible for rebuilding, redesigning, and implementing the systems, processes, and capabilities that help Clover succeed in our mission of improving health outcomes for our members and effecting change in the healthcare system. We collaborate with teams across the entire organization to ensure our members have access to the right care, at the right time, in the right setting.

We are looking to hire a Director of Internal Monitoring to support our growing operations function. In this role you will partner with key stakeholders across clinical and insurance operations as well as company leadership to ensure audit readiness and improve overall efficiency. You will leverage your deep Medicare Advantage background and expertise to develop and lead operational excellence and process improvement initiatives in support of Clover's goals and strategies.

As a Director of Internal Monitoring you will:

  • Build out and lead Clover's internal monitoring team.
  • Track and document pass / fail metrics across all areas of operations on a monthly cadence and escalate issues to the compliance committee as needed.
  • Ensure consistent and thorough internal oversight and accountability to SLA's of all First Tier, Downstream, and Related Entity vendors.
  • Partner with health plan operations leadership to build and monitor execution plans for outcomes-related goals such as process efficiency, operational expenses, plan performance, etc.
  • Establish dashboard and drive automation and consistency of all reporting across operations functions.

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 people person. You know how to communicate effectively to build trust and lasting partnerships with many different types of people, teams, and stakeholders.
  • You are a strategic prioritizer, and able to identify where and when to focus your energy.
  • You have a critical and analytical mindset. You understand how all the components of a process fit together and believe in the value of making data-driven decisions; you continuously monitor the efficacy of your programs through metrics tracking.
  • You are nimble, and comfortable working in a constantly evolving environment. You embrace ambiguity and speed while maintaining a bias towards action.

You should get in touch if:

  • You have at least 7 years experience in Medicare Advantage operations and a deep understanding of CMS guidelines and regulations.
  • You have experience successfully overseeing and managing internal monitoring or audit programs and/or significant experience leading Medicare Advantage operations.
  • You have a strong sense of urgency and a track record of holding people accountable to getting things done.
  • You have start-up experience in an entrepreneurial setting, preferred but not required.

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.