HEDIS Measure Owner (Abstractor)

We are seeking a HEDIS Measure Owner (Abstractor) that will be responsible for the end-to-end performance of assigned HEDIS measures, with a primary focus on achieving and sustaining 5-Star performance. This role goes beyond traditional chart abstraction and serves as a measure-level owner, accountable for ongoing monitoring, medical record abstraction, gap identification, and driving targeted interventions to improve outcomes. A key function of this role is to translate data and chart findings into actionable insights for providers, ensuring that care gaps are clearly identified and surfaced through tasks or alerts within clinical workflows. The goal is to simplify decision-making for providers, reduce administrative burden, and allow more time for direct patient care. The associate will function as a subject matter expert (SME) and partner cross-functionally with data, clinical, and provider engagement teams to ensure accurate reporting, efficient workflows, and optimal performance. As a HEDIS Measure Owner, you will: Own assigned HEDIS measure(s) with accountability for 5-Star performance. Monitor performance regularly, including: current rates and trends, gap-to-goal analysis, hits needed to achieve target performance. Review and abstract medical records as they are received. Maintain productivity expectations of 60-80 charts per day. Document findings accurately and aligned with NCQA HEDIS technical specifications. Conduct random audits of incoming data streams to validate completeness and accuracy. Partner with providers & clinical teams to close care gaps Provide insight into chart findings, documentation gaps, and missed opportunities. Act as a liaison between abstraction, clinical, and provider workflows. Validate data & collaborate cross-functionally to improve accuracy. Collaborate with data and analytics teams to: validate accuracy of data sources and identify gaps between claims, supplemental data, and chart findings. Serve as a subject matter expert (SME) on HEDIS measures and requirements. Serve as SME for grouping of assigned HEDIS measures across women's health, cardiovascular health, diabetes care, care transitions and management, or preventive screening. Maintain deep knowledge of: HEDIS technical specifications, Medicare Advantage STAR ratings, value sets and documentation requirements. Provide guidance to internal teams on measure interpretation and compliance. Success in this role looks like: First 90 days: Rapidly ramp on the Clover Assistant platform and assigned HEDIS measures, consistently reviewing 60-80 charts per day with strong accuracy. Begin contributing to gap closure by identifying care gaps and reliably translating findings into compliant, high-quality outputs. First 6 months: Proactively surface care gaps, near misses, and incomplete services, and convert insights into actionable provider interventions within CA and EHR workflows. Partner cross-functionally to improve gap closure strategies, refine provider alerts, and enhance data and reporting logic. First year: Drive meaningful improvements in quality performance, including progress toward 5-Star measures, while reducing provider administrative burden. Prioritize high-impact actions that streamline workflows, minimize unnecessary documentation, and enable providers to focus more on patient care. You should get in touch if: You have at least 2+ years of HEDIS Abstraction Experience. You have strong knowledge of Medicare Advantage and HEDIS measures and technical specifications. You have strong analytical and problem-solving skills. You have accountability and ownership mindset. You have strong attention to detail, data, and documentation accuracy. You have effective communication and collaboration. You have the ability to translate data and chart findings into actionable insights. You have the ability to work effectively in a remote environment. Preferred Associate's or Bachelor's degree in healthcare-related field (or equivalent experience). Experience with HEDIS abstraction tools. Experience working with EHR systems and provider workflows. Exposure to STAR ratings performance strategy.

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! 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. A reasonable estimate of the base salary range for this role is: $80,000-$100,000 USD Apply tot his job Apply To this Job