Job description
At Clover Health, we bring high-quality, affordable, and easy-to-understand healthcare plans to America’s seniors. We focus on preventive care and leverage data and technology from the Clover Assistant to empower physicians to make the best health recommendations based on our members’ complete health history—all with the lowest cost and the highest value.
The Provider Relations & Contracting Associate serves as the primary liaison between Clover Health and our provider network, including Fee-For-Service and Pay for Performance providers. This external-facing, field-based position requires expertise in provider relations, HEDIS, contracting, and partnership development to effectively engage high-priority providers and their staff.
Key responsibilities include educating providers on Clover Health initiatives, ensuring policy compliance, resolving issues promptly, and supporting sales growth, Clover Assistant and HEDIS Gaps-in-Care management. The role focuses on building strong provider partnerships while delivering exceptional customer service and driving improved coordination of care for Clover members.
As an Associate, Provider Relations & Contracting, you will:
- Be the face of Clover to market’s healthcare providers and serve as the primary point of contact for any/all assigned providers/practices.
- Support the formulation of various physician engagement strategies as part of building mutually beneficial partnerships in provider networks.
- Execute on provider contracting initiatives by engaging key providers throughout key markets.
- Manage provider relationships; engage contracted primary care and specialty physicians on a regular basis.
- Address and resolve operational challenges raised by network providers and effectively communicate those needs to internal stakeholders.
- Coordinate regular data transfer and feedback loops between physicians and Clover to ensure internal & external administrative cohesion.Conduct regular provider site visits within the assigned region/service area. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Clover policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Clover members.
- Provide on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship.
- Take initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.
- Independently deliver training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC’s).
- Perform an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various initiatives. Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.).
Success in this role looks like:
- By the end of your 90-day period:
- System Navigation: Demonstrate proficiency in navigating and utilizing key internal systems for provider outreach, logging interactions, tracking issues, and accessing relevant provider data.
- Network growth and Relationship Building: Encourage provider participation in HEDIS and other quality programs, leveraging your foundational knowledge of Clover Assistant to demonstrate their importance for member outcomes.
- By 6 months:
- Consistent Engagement: Maintain a regular cadence of communication and site visits with all assigned providers/practices, demonstrating consistent engagement and responsiveness.
- Educational Delivery: Independently deliver comprehensive training and presentations to assigned providers and their staff on various Clover Health topics, answering questions confidently.
- Issue Resolution: You’ll adeptly resolve provider issues through cross-departmental collaboration and independent problem-solving, leveraging your deep understanding of Clover Assistant to enhance care delivery and directly improve Stars measurement and overall plan performance.
- Future success in this role will be measured through:
- High Provider Retention: Consistently achieve high retention rates for assigned providers within the Clover network, indicating strong, mutually beneficial partnerships.
- Network Growth & Optimization: You’ll play a vital role in optimizing our existing provider network in New Jersey. Directly contribute to sales and membership growth initiatives by ensuring a robust, engaged, and high-performing provider network.
- Partnership Development: Cultivate deep, strategic partnerships with high-priority providers and health systems, leading to collaborative programs, shared goals, and enhanced value for members.
You should get in touch if:
- You have 5+ years of healthcare industry experience in one or more of the following areas: provider network management, provider relations, insurance operations, or payment integrity functions.
- You have a strong background in provider relations, HEDIS, contracting, and partnership development.
- You are based in South New Jersey.
- You have a valid New Jersey driver’s license and reliable transportation.
- You thrive in an external-facing, field-based role and enjoy engaging directly with healthcare providers, including physicians and office staff.
- You’re skilled at building and managing relationships with healthcare providers, ensuring their satisfaction and education on key initiatives.
- You’re adept at delivering training and presentations to both individual providers and larger groups, such as health system executives.
- You have experience supporting network growth and optimization initiatives within a healthcare payer environment.
- You’re committed to improving administrative cost effectiveness, member satisfaction (CAHPS), and quality programs through provider engagement.
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.
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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.
A reasonable estimate of the base salary range for this role is $80,000 to $90,000. 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.
