Senior Director, HEDIS Operations

Senior Director, HEDIS 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.

As the Senior Director of HEDIS Operations, you will own and run Clover Health's HEDIS abstraction processes, ensuring our organization sustains and extends its industry-leading HEDIS and Stars performance. You will be directly responsible for achieving outcomes in Measurement Year 2025 and beyond, bringing unmatched expertise in abstraction, audit readiness, and numerator / exclusion management. You will work across technical, analytical, and clinical teams to operationalize HEDIS results and deliver measurable impact.

As a Senior Director of HEDIS Operations, you will :

• Lead and oversee Clover Health's HEDIS abstraction and submission processes, ensuring timely and accurate execution.
• Manage a team of abstraction experts
• Partner with analytics and technical teams to ensure data quality supports numerator capture, exclusions, and supplemental data submission.
• Serve as the company's subject matter expert for HEDIS specifications, auditor engagement, and measure interpretation.
• Develop and refine processes to maximize numerator hits, manage exclusions, and ensure correct denominator definitions for all measures.
• Ensure operational readiness for HEDIS audits, including preparation, submission accuracy, and remediation processes.
• Collaborate cross-functionally with clinical and operational leaders to close gaps and translate abstraction into improved Stars performance.
• Drive daily accountability to outcomes, ensuring abstracted results translate into measurable gains in HEDIS and Stars.

Success in this role looks like :

You should get in touch if :

Benefits Overview :

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.