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.
We are looking for a Senior Manager, Network Operations, who will play a key role in managing and optimizing network operational processes. This role will primarily focus on project management of critical network operations tasks, including but not limited to ensuring timely and accurate ingestion of provider contracts, maintaining and improving provider CRM solution, assisting with strategic network performance analysis, and ensuring an overall improved provider experience through cross-functional collaboration with various Operations and Compliance internal stakeholders as well as external BPaaS stakeholders.
As a Senior Manager, Network Operations, you will:
Oversee the day-to-day execution of optimizing network operational processes. The ideal candidate has a deep understanding of Medicare Advantage operations, demonstrates strong leadership skills, and excels in problem-solving, project management, and stakeholder management.
This is an excellent opportunity for an experienced project manager with a strong understanding of network operations within the healthcare space.
Key Responsibilities:
Network Operations Oversight
- Develop, implement, and refine operational processes and workflows to improve provider onboarding experience
- Project manage numerous strategic in-house projects designed to drive improved management and oversight of Network Operations
Compliance and Regulatory Management
- Monitor and interpret CMS regulatory changes impacting Medicare Advantage plans, ensuring network operations reflect current requirements.
- Work with compliance and legal teams to address any discrepancies and maintain adherence to federal and state regulations.
Cross-Functional Collaboration
- Coordinate with Provider Data Management, Credentialing, Configuration, and Network Contracting and Management to facilitate a best of class provider onboarding experience.
- Act as the primary contact between BPaaS partner and Network to support problem-solving and issue resolution.
- Manage vendor relationships and third-party partnerships to ensure compliance and service delivery standards are met.
- Collaborate cross-functionally with operational, regulatory, and quality teams to ensure Network Operations aligns with Clover Health’s overall strategic goals and compliance requirements.
Process Improvement and Automation
- Identify and implement process improvements to streamline provider contract ingestion, enhance quality control, and drive an improved provider onboarding experience
- Drive the development and integration of automated solutions to improve efficiency and accuracy in plan configuration.
- Monitor and respond to provider feedback and challenges, resolving issues quickly and ensuring a positive experience for our partners.
Team Leadership and Development
- Supervise and mentor a team, fostering a culture of excellence, accountability, and continuous learning.
- Develop and maintain documentation, training materials, and best practices for configuration procedures.
Assist Network Contract & Management team with analysis of network performance metrics and leverage data to identify opportunities for optimization and cost-effectiveness.
Success in this role looks like:
By the end of your 90-day period:
- Assessed current network operational processes: Conducted a thorough review of existing provider contract ingestion processes and provider onboarding workflows, identifying key pain points and areas for immediate improvement.
- Established foundational stakeholder relationships: Built strong working relationships with key internal teams (e.g., Provider Data Management, Credentialing, Configuration, Network Contracting and Management, Compliance) and the primary BPaaS partner to understand their needs and challenges.
- Identified initial project priorities: Collaborated with leadership to pinpoint and prioritize the most critical in-house projects to drive network operations improvements, with a clear understanding of scope and initial milestones.
By 6 months:
- Initiated key process improvements: Successfully implemented at least three significant process improvement or workflow refinement to streamline provider contract ingestion or enhance the provider onboarding experience.
- Driven progress on strategic projects: Actively project managed and achieved significant milestones on at least two strategic in-house projects, moving them closer to completion and demonstrating early impact on network oversight.
- Strengthened vendor collaboration: Optimized the relationship with the BPaaS partner, establishing clear communication channels and problem-solving protocols that lead to more efficient issue resolution and service delivery.
- Began team development: Started to mentor and develop your direct reports, fostering a collaborative and accountable team environment.
Future success in this role will be measured through:
- Sustained improvement in provider experience: Reduced resolution times for provider inquiries and issues, driven by optimized processes and effective cross-functional collaboration.
- Measurable operational efficiency and accuracy: Ongoing reduction in manual efforts, error rates, and processing times for key network operations tasks (e.g., contract ingestion, configuration accuracy) through continuous process improvement and automation.
- Proactive regulatory compliance: Consistent adherence to CMS regulations and state requirements, evidenced by successful audits and seamless adaptation to regulatory changes impacting network operations.
You should get in touch if:
- You have 7+ years of experience in Medicare Advantage or healthcare plan operations or audit, with ideally at least 3 years in a managerial or leadership role.
- You are proficient in software systems (e.g., salesforce, google suite, etc.).
- You have comprehensive knowledge of CMS regulations and Medicare Advantage compliance requirements.
- You demonstrate strong project management, problem-solving, and decision-making abilities.
- You demonstrate excellent verbal and written communication and presentation skills with the ability to communicate complex concepts across multiple disciplines.
- You have training and talent development experience.
- You have experience in cross-functional stakeholder and vendor management.
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 $150,000 - $165,000. 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.
