Director – Network Performance
Clover Health
full-time
Posted on:
Location Type: Remote
Location: New Jersey • United States
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Salary
💰 $160,000 - $190,000 per year
Job Level
About the role
- Lead the development and execution of Clover’s provider network strategy in New Jersey, including maintaining network adequacy and coverage, advancing strategic growth, and directing data-driven reviews and action plans across all specialties.
- Establish and execute on an annual contracting roadmap aligned with affordability, access, and quality goals.
- Lead a team to deliver high-quality and data-driven contracting operations for PCP, specialist, ancillary and hospital entities.
- Oversee provider contracting activities, including new agreements, renegotiations, amendments, and escalations.
- Ensure CMS and state network adequacy compliance.
- Serve as the escalation point for complex provider negotiations, rate exceptions, and redline decisions.
- Implement contracting governance, including contract lifecycle management.
- Partner with Legal, Finance, Compliance, UM, and Claims to ensure operational readiness and consistency across all provider agreements.
- Ensure analytics are accurate, repeatable, and used to drive contracting priorities.
- Own provider intake governance and decision-making, and establish and monitor team SLAs for contracting throughput.
- Create and deliver Network dashboards for leadership, including key progress points, major initiatives, adequacy status, contracting pipeline and/or OON savings.
- Drive continuous improvement across workflows, documentation, and provider experience.
Requirements
- You have a Bachelor’s Degree (strongly preferred)
- You have 8+ years of provider contracting experience, with direct responsibility for hospitals, large groups, and ancillary providers.
- You have 5+ years leading a network contracting team for a large entity.
- You possess deep knowledge of Medicare Advantage network regulations, adequacy standards, and reimbursement methodologies.
- You have experience leading multi-state networks or geographically diverse provider contracting teams.
- You have demonstrated ability to manage complex negotiations and resolve escalated provider issues.
- You have experience building processes, SLAs, dashboards, and scalable operational governance.
- You have strong analytical skills; ability to use data to drive decision-making and prioritization.
- You have excellent communication and relationship management abilities.
Benefits
- 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!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
provider contractingcontract lifecycle managementdata analysisnetwork adequacy complianceMedicare Advantage regulationsreimbursement methodologiescontracting operationsnegotiationdashboard creationprocess building
Soft Skills
leadershipcommunicationrelationship managementanalytical skillsproblem-solvingteam managementstrategic thinkingcontinuous improvementdecision-makingcollaboration
Certifications
Bachelor's Degree