Job Description
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 one of the most proactive, data-driven health care services platforms and is excited about how technology impacts our ability to bring transformative results to both patients and providers.
The Director, Provider Network is a strategic, data-driven leader who manages Clover’sprovider contracting team in New Jersey. In this role you 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 superior member and provider experience.
Although this role is remote we are looking for someone in the NYC/NJ Metro area who has worked in and understands this market.
You will lead a high-impact team responsible for contracting, network adequacy, out-of-network cost management, Single Case Agreements (SCAs), and provider intake. You will balance strategy and execution, thrive in a fast-moving environment, and build scalable processes that meet both regulatory and operational needs.
As a Director, Network Performance, you will:
- 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.
Success in this role looks like:
- High provider satisfaction, measured through responsiveness, issue resolution, and clear communication.
- Network adequacy across all contracted counties.
- Clear, documented workflows and strong SLA performance across intake, contracting, renegotiations and adequacy.
- Accountability and execution of contracting across all specialities and entity types.
You should get in touch if:
- 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 Overview:
- 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!
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, perspectives, opinions, 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.
#LI-REMOTE
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.
Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.
A reasonable estimate of the base salary range for this role is:
$160,000—$190,000 USD
