About the job
At Clover Health, we are committed to enhancing the lives of seniors through innovative, data-driven physician enablement technology. Initially launched within our own Medicare Advantage provider network, we have developed a pioneering technology platform that delivers actionable clinical insights to physicians right at the point of care. In 2024, Clover’s PPO plan achieved an impressive 4.94 stars in HEDIS, significantly influenced by our advanced technology - Counterpart Assistant. Discover how this innovation contributed to our success in our case study here.
As the Director of HEDIS Business Operations, you will be the key liaison among Clover’s clinical, analytical, and operational teams to drive measurable HEDIS outcomes. You will conceptualize and manage initiatives—from incentives to member engagement—that directly enhance numerator closure, collaborating with HEDIS Operations to ensure a seamless transition from program design to abstraction, audit, and submission. Your ultimate goal is to implement programs that guarantee members of Clover’s Medicare Advantage plan receive the highest standard of clinical quality.
Responsibilities include:
- Leading the strategic business execution for HEDIS outcomes, focusing on programs that effectively close care gaps for members across various interaction channels, including provider incentive programs, call center outreach, mailing lab testing kits, and chart chase and abstraction.
- Establishing and managing incentive structures and provider engagement models that drive numerator closure.
- Developing and overseeing cross-functional initiatives that translate measure logic into actionable programs organization-wide.
- Collaborating with HEDIS Operations to ensure business programs align with abstraction and submission workflows for an integrated process.
- Managing scenario planning for HEDIS measure cutpoints and Stars implications, steering the organization toward impactful interventions.
- Proactively preparing for measure evolution (hybrid to admin, admin to digital, display to official), ensuring Clover remains ahead of industry changes.
- Tracking and communicating performance outcomes, highlighting risks, opportunities, and ROI of interventions to senior leadership.

