Senior Manager, Quality Improvement

At Clover Health we are committed to providing high-quality affordable and easy-to-understand healthcare plans for Americas seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each members complete health history we ensure better care at a lower costdelivering the highest value to those who need it most.

This role requires an experienced Registered Nurse (RN) with strong knowledge of regulatory requirements QI methodology and Medicare Advantage program compliance. You will partner cross-functionally with internal and external stakeholders to strengthen Clovers QI Program ensuring compliance operational excellence and continuous improvement in care delivery.

As a Senior Manager Quality Improvement you will :

• Oversee Regulatory QI Program Elements

Lead development and maintenance of the Annual Quality Improvement Program Description and Annual QI Work Plan in compliance with CMS MMCM Chapters 4 and 5.

Ensure CMS NCQA and state QI requirements are met and documented.

Oversee Quality of Care (QOC) investigations including case review root cause analysis and corrective action planning.

Support Star Ratings strategy by evaluating performance data and identifying barriers to improvement.

Supervise a team of QI professionals providing coaching and professional development.

Success in this role looks like :

Understand Clover Healths QI program CMS MMCM requirements and regulatory obligations.

Update or implement QI program elements to ensure regulatory compliance.

Maintain full regulatory compliance and audit readiness.

You should get in touch if :

Benefits Overview :

Additional Perks :

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 weve 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.

From Clovers 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 peoples lives. Diversity not only includes race and gender identity but also age disability status veteran status sexual orientation religion and many other parts of ones identity. All of our employees points of view are key to our success and inclusion is everyones responsibility.

Pursuant to the San Francisco Fair Chance Ordinance we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

A reasonable estimate of the base salary range for this role is $140000 to $171000. Final pay is based on several factors including but not limited to internal equity market data and the applicants education work experience certifications etc.

#LI-Remote

Required Experience :

Senior Manager

Key Skills

Business Intelligence,Children Activity,Business Analysis,Corporate Sales,ABB,Corporate Development

Employment Type : Full Time

Experience : years

Vacancy : 1

Monthly Salary Salary : 140000 - 171000