Director, HEDIS Operations
176000 - 200000 USD per year
Company:Clover Health
Location:United States
Languages:English
Seniority level:Director, 10+ years
Experience:10+ years
Skills:
LeadershipProject ManagementPeople ManagementQACross-functional Team LeadershipOperations ManagementCompliance
Requirements:
10+ years of experience leading HEDIS or Stars operations for a Medicare Advantage plan or vendor Deep expertise in HEDIS abstraction processes, NCQA specifications, CMS Stars methodology, and audit practices Successfully managed hybrid and prospective review models at scale Known for achieving high HEDIS and Stars performance Thrive in high-stakes, outcomes-driven environments
Responsibilities:
Lead and oversee Clover Health’s HEDIS abstraction and submission processes Manage a team of abstraction experts Partner with analytics and technical teams to ensure data quality Serve as the company’s subject matter expert for HEDIS specifications Develop and refine processes to maximize numerator hits Ensure operational readiness for HEDIS audits Collaborate cross-functionally with clinical and operational leaders Drive daily accountability to outcomes
