Director, Network Performance Remote - USA
Clover Health, LLC, Trenton, NJ, United States
Overview
The Clover Care Services organization delivers proactive support and care to our members through our clinical Clover Home Care teams, and quality improvement services to our aligned providers through our Managed Care Organization. Clover has built a data‑driven health care services platform and seeks a strategic, data‑driven leader to manage Clover’s provider contracting team in New Jersey. Director, Provider Network will partner with the VP of Network Performance to oversee the design, execution, and optimization of Clover’s provider network strategy across all markets in New Jersey, ensuring CMS and state regulatory requirements are met, cost efficiency, and a superior member and provider experience. This role is remote, with preference for candidates in the NYC/NJ Metro area who understand this market. Responsibilities
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 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 progress points, major initiatives, adequacy status, contracting pipeline and/or OON savings. Drive continuous improvement across workflows, documentation, and provider experience. Qualifications
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 entity. Deep knowledge of Medicare Advantage network regulations, adequacy standards, and reimbursement methodologies. Experience leading multi‑state networks or geographically diverse provider contracting teams. Proven ability to manage complex negotiations and resolve escalated provider issues. Experience building processes, SLAs, dashboards, and scalable operational governance. Strong analytical skills with the ability to use data to drive decision‑making and prioritization. Excellent communication and relationship management abilities. Benefits Overview
Financial Well‑Being:
Competitive base salary and equity opportunities, performance‑based bonus, 401k matching, and regular compensation reviews. Physical Well‑Being:
Comprehensive medical, dental, and vision coverage. Mental Well‑Being:
Initiatives such as No‑Meeting Fridays, monthly company holidays, mental health resources, flexible time‑off, and remote‑first culture. Professional Development:
Learning programs, mentorship, development funding, and regular performance feedback. Employee stock purchase plan (ESPP) and other supports. Equal Opportunity Employer. Clover Health is committed to a diverse and inclusive workplace. We do not discriminate on the basis of protected characteristics and comply with applicable laws. ##LI-REMOTE Final pay is based on several factors including internal equity, market data, and the applicant’s education, experience, and certifications.
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The Clover Care Services organization delivers proactive support and care to our members through our clinical Clover Home Care teams, and quality improvement services to our aligned providers through our Managed Care Organization. Clover has built a data‑driven health care services platform and seeks a strategic, data‑driven leader to manage Clover’s provider contracting team in New Jersey. Director, Provider Network will partner with the VP of Network Performance to oversee the design, execution, and optimization of Clover’s provider network strategy across all markets in New Jersey, ensuring CMS and state regulatory requirements are met, cost efficiency, and a superior member and provider experience. This role is remote, with preference for candidates in the NYC/NJ Metro area who understand this market. Responsibilities
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 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 progress points, major initiatives, adequacy status, contracting pipeline and/or OON savings. Drive continuous improvement across workflows, documentation, and provider experience. Qualifications
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 entity. Deep knowledge of Medicare Advantage network regulations, adequacy standards, and reimbursement methodologies. Experience leading multi‑state networks or geographically diverse provider contracting teams. Proven ability to manage complex negotiations and resolve escalated provider issues. Experience building processes, SLAs, dashboards, and scalable operational governance. Strong analytical skills with the ability to use data to drive decision‑making and prioritization. Excellent communication and relationship management abilities. Benefits Overview
Financial Well‑Being:
Competitive base salary and equity opportunities, performance‑based bonus, 401k matching, and regular compensation reviews. Physical Well‑Being:
Comprehensive medical, dental, and vision coverage. Mental Well‑Being:
Initiatives such as No‑Meeting Fridays, monthly company holidays, mental health resources, flexible time‑off, and remote‑first culture. Professional Development:
Learning programs, mentorship, development funding, and regular performance feedback. Employee stock purchase plan (ESPP) and other supports. Equal Opportunity Employer. Clover Health is committed to a diverse and inclusive workplace. We do not discriminate on the basis of protected characteristics and comply with applicable laws. ##LI-REMOTE Final pay is based on several factors including internal equity, market data, and the applicant’s education, experience, and certifications.
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