Remote-First Network Navigator

Clover Health; Jersey City (NJ); On-site; USD 115,000 - 150,000; Full time

Benefits offered by this job

Bonus program

401k matching

Medical coverage

Mental health resources

Professional development

ESPP

Remote-friendly culture

Parental leave

Tech stipend

Office setup reimbursements

Job summary

Clover Health is seeking a Specialist Navigator to bridge Network Performance and specialist providers, translating analytics into action to improve quality and cost outcomes. This role requires collaboration across analytics, clinical, and network teams and involves substantial travel within the Northeast region.

You will influence contracting, provider engagement, and utilization strategies while supporting population health goals and value-based care initiatives across the network.

Responsibilities

• Serve as the primary liaison between Network Performance and specialist providers, driving initiatives and ensuring analytics findings translate into measurable improvements.
• Partner with Network Performance to develop contracts for specialist and ancillary providers that support a high-performing network.
• Cultivate trusted relationships with specialist providers to improve quality, access, affordability, and network performance.
• Lead data-driven discussions with providers on utilization trends, referral patterns, site-of-service opportunities, and practice variation.
• Identify barriers to outpatient utilization with specialists and implement strategies to improve effectiveness and efficiency where clinically appropriate.
• Educate providers on scheduling practices to support network optimization while maintaining quality outcomes and member access.
• Monitor provider adoption of recommendations and assess shifts in referral behavior after engagement efforts.
• Leverage analytics insights to identify opportunities, prioritize outreach, and measure intervention effectiveness.
• Track and report KPIs such as ASC utilization, outpatient migration, provider engagement, and cost savings.

Job description

Clover Health is seeking a Specialist Navigator to bridge Network Performance and specialist providers, translating analytics into action to improve quality and cost outcomes. This role requires collaboration across analytics, clinical, and network teams and involves substantial travel within the Northeast region.

You will influence contracting, provider engagement, and utilization strategies while supporting population health goals and value-based care initiatives across the network.