Clover is reinventing health insurance to keep people healthier.
The Clinical Operations team is responsible for ensuring patients have access to the right care at the right time, in the right setting. Our cross functional group of nurses, coordination support, and operations staff work together to ensure timely review and personalized clinical decision-making that supports our members and is compliant with CMS regulations.
As an Operations Associate, you will ensure our UM operations, in-patient facility relationships, technical integrations, and field services are aligned to drive continued success and scalability of the post-discharge program. Additionally, you will ensure that critical in-patient touch points through the UM channel can be leveraged for additional care management activities.
As an Operations Associate, you will:
- Partner with technical and operational teams to implement new data sources into Clover processes. You'll grow deep operational intelligence, serve as a strong thought partner, and empower process improvements.
- Partner with the Provider Alignment/Network Management team on program needs to ensure in-patient contracts reflect technical and process requirements.
- Collaborate with hospital case management teams to align on process and resource allocation expectations and support implementations.
- Experiment and generate data-driven learnings about the operational, technical, and financial requirements that unlock optimized UM/ hospitals partnerships to further reduce medical expenses and numerous healthcare effectiveness performance scores, including All Cause Readmissions.
- Operationalize new cross-functional programs to support new measures that will further improve Clover's star rating.
- Develop or expand performance metrics and funnels for data driven decision making across operations.
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 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 3+ years of prior experience in a blend of technology and operations, building scalable programs from scratch and iterating on them.
- You have prior experience in care management.
- You can dig into the weeds but also think big picture - you're able to relate the inputs and outputs of systems or processes to their overall business value and impact.
- You are a clear and concise communicator and know how to tailor your message to your audience.
- You have some healthcare or start-up (or healthcare start-up) experience, although not required.
- You have (or are excited to develop) strong SQL skills.
- You are excited by the prospect of building a better healthcare system from the ground up.
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 and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.