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Director, Network Performance

1 hour, 53 minutes ago
United States
Full-time
Lead
Operations Manager
Operations
Apply Now
Clover Health

Clover Health

Clover Health is a data-focused health insurance company that is revolutionizing the Medicare Advantage space by integrating innovative technology into its plans. With a focus on optimizing medical outcomes and reducing costs, Clover Health uses analyt...

Insurance
251-1K
Founded 2014
$925M raised
View All Jobs 30

Description

  • Lead the development and execution of Clover’s provider network strategy in New Jersey across all specialties.
  • Establish and manage an annual contracting roadmap aligned with affordability, access, and quality goals.
  • Lead provider contracting operations for primary care physicians, specialists, ancillary providers, and hospitals.
  • Oversee new agreements, renegotiations, amendments, escalations, and other provider contracting activities.
  • Ensure CMS and New Jersey state network adequacy compliance.
  • Serve as the escalation point for complex provider negotiations, rate exceptions, and redline decisions.
  • Implement contracting governance and contract lifecycle management processes.
  • Partner with Legal, Finance, Compliance, UM, and Claims to ensure operational readiness and consistency across agreements.
  • Own provider intake governance, set team SLAs, and monitor contracting throughput.
  • Build and deliver network dashboards and reporting for leadership on progress, initiatives, adequacy, pipeline, and out-of-network savings.
  • Drive continuous improvement across workflows, documentation, and provider experience.

Requirements

  • Bachelor’s degree strongly preferred.
  • 8+ years of provider contracting experience with direct responsibility for hospitals, large groups, and ancillary providers.
  • 5+ years leading a network contracting team for a large organization.
  • Deep knowledge of Medicare Advantage network regulations, adequacy standards, and reimbursement methodologies.
  • Experience leading multi-state networks or geographically diverse provider contracting teams.
  • Demonstrated ability to manage complex negotiations and resolve escalated provider issues.
  • Experience building processes, SLAs, dashboards, and scalable operational governance.
  • Strong analytical skills and the ability to use data to drive decision-making and prioritization.
  • Excellent communication and relationship management abilities.
  • Remote role requires a candidate located in the NYC/NJ metro area with experience in that market.

Benefits

  • Competitive base salary of $160,000 to $190,000 USD.
  • Equity opportunities, including an Employee Stock Purchase Plan with discounted equity.
  • Performance-based bonus program.
  • 401(k) matching.
  • Comprehensive medical, dental, and vision coverage.
  • Flexible time-off policy and No-Meeting Fridays.
  • Access to mental health resources and monthly company holidays.
  • Remote-first culture with reimbursement for office setup expenses and a monthly cell phone and internet stipend.
  • Learning programs, mentorship, professional development funding, and regular performance feedback.
  • Paid parental leave for all new parents.

Interested in this position?

Apply directly on the company website

Apply Now

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