Director, Network Management & Operations – Clover Health

11% 1-Year Employee Growth Rate | 63% 2-Year Employee Growth Rate | LinkedIn | $1.3B Venture Funding

What Is Employee Growth Rate & Why Is It Important?

Clover is reinventing health insurance by working to keep people healthier.

 

Clover Health is a Medicare Advantage and Prescription Drug plan that is changing how healthcare is delivered. The health care delivery system is undergoing many changes, however most health insurance payers are trying to execute this change with decades old processes and technologies in a top-down framework. In this role, you will have the opportunity to engage with forward thinking health systems with the goal of implementing programs in a data driven manner to improve the lives of our members.

 

As Director, Network Management and Operations you will:

• Be the face of Clover Health’s Network Management team within current and new markets.
• Lead the strategy, development and execution of Clover’s Medicare Advantage and DCE/ACO REACH recruitment, sales strategies and ongoing engagement with providers, hospitals, health systems and ancillary partners.
• Manage all processes and analytics to support both strategic and operational network management activities.
• Formulate and launch engagement/contracting strategies for stakeholders across both Medicare Advantage and Medicare Fee-for-Service lines of business to deliver high-quality and efficient care delivery. 
• Lead and manage a national network management team to drive our technology engagement, quality, and medical expense goals.
• Engage and partner cross-functionally with marketing, legal, finance, medical economics, provider engagement and other internal teams to support network management, network development and other organizational initiatives.

 

You will love this job if:

• You are passionate about transforming the health delivery through data driven analysis and development of new technologies.
• You have an insatiable curiosity which feeds an appetite to learn and teach.
• You want to make an impact. You thrive off of helping others and want your work to make a difference in our members' lives, while also advocating for their needs.
• You are a people person – you know how to communicate effectively to build trust and positive relationships with many different types of people, teams, and partners.
• You are nimble, and comfortable working in a constantly evolving environment. You embrace ambiguity and speed while maintaining a bias towards action.

 

You should get in touch if:

• You have 10+ years of experience in network management, provider contracting, and/or managed care.
• You have 6+ years experience leading and managing cross-functional teams against strategic goals. 
• You have a comprehensive understanding of contractual options, healthcare economics and competitors practices with the ability to grasp both clinical and business concepts.
• You know how to interpret fee-for-service and value-based program requirements and understand the impact on financial performance.
• You understand key components of value-based payer programs (risk and successful tactics needed to improve quality and generate savings).
• Have proven experience negotiating contracts to improve overall performance; flexing details quickly based on real-time conversations.
• You have a MBA/MPH (preferred).

#LI-Remote #LI-JE1

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

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About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

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 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.

Tagged as: >50% 2 Yr Employee Growth, 501+ Employees, Hide US-Only Jobs, Venture Funded