Director, HEDIS Operations

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

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