Clover Health “makes healthcare work” through its commitment to improving and reinventing the way the industry pursues healthcare and insurance in the Unite

Senior Manager, Quality Improvement

ManagerManagerFull TimeRemoteSeniorCompany Site

Location

United States

Posted

130 days ago

Salary

$140K - $171K / year

Seniority

Senior

Bachelor Degree3 yrs expEnglish

Job Description

• Oversee Regulatory QI Program Elements: lead development and maintenance of the Annual Quality Improvement Program Description and Annual QI Work Plan, ensure timely completion of annual QI Program Evaluation, manage QI Committee activities. • Regulatory Compliance & Audit Readiness: ensure CMS, NCQA, and state QI requirements are met, maintain audit readiness for CMS Program Audits, partner with Legal and Compliance teams. • Quality of Care Oversight: oversee Quality of Care investigations, collaborate with Medical Directors and clinical teams. • Performance Monitoring & Improvement: support Star Ratings strategy, present QI outcomes, implement cross-functional improvement initiatives. • Leadership & Collaboration: supervise QI professionals, lead cross-departmental working groups, foster a culture of quality, compliance, and continuous improvement.

Job Requirements

Active, unrestricted RN license (required).
Bachelor’s degree in Nursing or a related field (Master’s preferred).
Minimum 3 years of experience in Medicare Advantage or similar managed care setting.
Deep knowledge of CMS MMCM Chapter 4 (Benefits & Beneficiary Protections) and Chapter 5 (Quality Improvement Program) requirements.
Experience in regulatory compliance, QI program oversight, and audit readiness.
At least 3 years of leadership experience, including direct team management.
Strong skills in data analysis, performance monitoring, and process improvement.
Proficiency with Microsoft Office and Google Suite.
Excellent written and verbal communication skills; ability to present to executive leadership and committees.

Benefits

Financial Well-Being: competitive base salary and equity opportunities, performance-based bonus program, 401k matching, regular compensation reviews.
Physical Well-Being: comprehensive medical, dental, and vision coverage.
Mental Well-Being: initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, generous flexible time-off policy, remote-first culture supporting collaboration.
Professional Development: learning programs, mentorship, professional development funding, regular performance feedback and reviews.
Additional Perks: Employee Stock Purchase Plan (ESPP), reimbursement for office setup expenses, monthly cell phone & internet stipend, paid parental leave for all new parents.