Senior Healthcare Operations & Analytics Advisor (Hybrid)

Clever Care Health Plan; Huntington Beach (CA); Hybrid; USD 110,000 - 145,000; Full time

Benefits offered by this job

Hybrid work model

Huntington Beach office

Job summary

Clever Care Health Plan is rapidly expanding in Southern California, offering Medicare Advantage plans and a hybrid work model with three days onsite at the Huntington Beach office. The Senior Business Process Advisor will bridge Risk Adjustment, Quality/Stars, Clinical Operations, Analytics, and IT to translate CMS requirements into scalable workflows and reporting solutions.

Responsibilities include leading UAT, developing dashboards, and ensuring data integrity across Stars, HEDIS, CAHPS,

Qualifications

• Medicare Stars and HEDIS reporting and operational support.
• Risk Adjustment analytics and reporting.
• Provider performance reporting and scorecard development.
• Predictive modeling and healthcare analytics.
• CMS regulatory interpretation and operational implementation.
• Experience with Salesforce reporting environments.
• UAT leadership and execution skills.
• Advanced SQL skills.

Responsibilities

• Partner with business stakeholders to understand operational challenges, strategic priorities, and reporting needs.
• Facilitate requirements gathering sessions with Quality, Risk Adjustment, Clinical Operations, Provider Relations, Analytics, and IT teams.
• Translate business objectives into detailed functional and technical requirements.
• Create business requirements documents, process flows, use cases, user stories, data dictionaries, and testing plans.
• Evaluate existing workflows and identify opportunities for automation, standardization, and operational improvement.
• Ensure business requirements remain aligned with CMS, NCQA, HEDIS, Stars, CAHPS, and CMS Risk Adjustment requirements.

Skills

Medicare Stars and HEDIS reporting

Risk Adjustment analytics

Provider performance reporting

Predictive modeling

CMS regulatory interpretation

Salesforce reporting

UAT leadership

Advanced SQL

Power BI/Tableau

Education

Bachelor's degree in Healthcare Administration, Business Administration, Public Health, Information Systems, Data Analytics, or related field

Tools

Salesforce

Power BI

Tableau

Job description

Clever Care Health Plan is rapidly expanding in Southern California, offering Medicare Advantage plans and a hybrid work model with three days onsite at the Huntington Beach office. The Senior Business Process Advisor will bridge Risk Adjustment, Quality/Stars, Clinical Operations, Analytics, and IT to translate CMS requirements into scalable workflows and reporting solutions.

Responsibilities include leading UAT, developing dashboards, and ensuring data integrity across Stars, HEDIS, CAHPS,