Director, HEDIS Business Operations

Director, HEDIS Business Operations

At Clover Health, we are dedicated to improving the lives of seniors through high-quality, data-driven physician enablement technology. Initially scaled within our own Medicare Advantage provider network, we have built an innovative technology platform, designed to put actionable clinical insights into the hands of physicians at the point of care.

In 2024, Clover's PPO plan achieved an industry leading 4.94 stars in HEDIS, with significant impact driven by its innovative technology - Counterpart Assistant. Read more about how CA drove this improvement in our case study here.

As the Director of HEDIS Business Operations, you will serve as the connector across Clover's clinical, analytic, and operational teams to deliver measurable HEDIS impact. You will design and manage the programs, ranging from incentives to member engagement, that directly drive numerator closure, while partnering with HEDIS Operations to ensure seamless alignment from program design through abstraction, audit, and submission. Ultimately, you will design programs to ensure members of Clover's Medicare Advantage plan are always provided with the industry's leading clinical quality.

As a Director, HEDIS Business Operations you will:

• Lead the business strategy and execution for HEDIS outcomes, focusing on programs that ultimately yield success in closing care gaps for members across the various interaction channels available - ranging from provider incentive programs, call center outreach, mailing lab testing kits, to chart chase and abstraction.
• Establish and manage incentive structures and provider engagement models that directly drive numerator closure.
• Develop and oversee cross-functional initiatives that translate measure logic into actionable programs across the organization.
• Partner with HEDIS Operations to ensure business programs align with abstraction and submission workflows, creating a seamless end-to-end process.
• Own scenario-planning for HEDIS measure cutpoints and Stars implications, guiding the organization toward the interventions that will drive results.
• Anticipate and prepare for measure evolution (hybrid to admin, admin to digital, display to official), ensuring Clover is strategically positioned for future changes and always ahead of the industry changes.
• Track and communicate performance outcomes, highlighting risks, opportunities, and ROI of interventions to senior leadership.

Success in this role looks like:

• Building high-functioning programs across provider, call center, and care coordination teams that directly contribute to numerator closure and improved Stars ratings.
• Clear ownership of business levers tied to HEDIS outcomes, complementing the abstraction and audit work of the HEDIS Operations teams.
• Proactive adaptation of programs to reflect evolving NCQA, CMS, and industry changes.
• Strong alignment between Stars strategy and HEDIS programs, ensuring organizational resources are focused on the highest-impact measures.

You should get in touch if:

• You have 7+ years of experience in healthcare program management and strategy.
• You have led cross-functional programs that align multiple stakeholders toward a common outcome.
• You are highly analytical, able to interpret performance data and translate it into effective interventions.
• You understand the HEDIS and Stars landscape and are motivated by the business and programmatic levers that deliver results.
• You thrive in a dynamic, high-stakes environment where success is measured in outcomes, not activity.

Benefits Overview:

• Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
• Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
• Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
• Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.

Additional Perks:

• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remote-first culture, enabling collaboration with global teams
• Paid parental leave for all new parents
• And much more!

About Counterpart Health: In 2018, Clover Health set out to do something unprecedented: build a clinically intuitive, AI-enabled solution that fits within physicians' workflows to help support the earlier diagnosis and management of chronic conditions.

Years later, that vision is a reality, with thousands of practitioners using Counterpart Assistant during patient visits to improve disease management, reduce medical expenses, and drive success in value-based care.

With an exceptional team of value-based care and technology experts, Counterpart Health is driving value-based care at the speed of software.

Counterpart Health is a subsidiary of Clover Health. From Clover's inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one's identity. All of our employee's points of view are key to our success, and inclusion is everyone's responsibility.

A reasonable estimate of the base salary range for this role is $176,000 to $200,000. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant's education, work experience, certifications, etc.