Remote Specialist Network Navigator

Clover Health; Orangeburg (SC); On-site; USD 115,000 - 150,000; Full time

Benefits offered by this job

Employee Stock Purchase Plan

Office setup reimbursement

Cell phone stipend

Remote-first culture

Paid parental leave

Job summary

The Specialist Navigator at Clover Health serves as the primary liaison between Clover's Network Performance team and specialist providers, translating data-driven insights into action to improve quality, access, affordability, and network outcomes.

You will develop and maintain relationships with providers, negotiate contracts, monitor utilization trends, and contribute to strategic network optimization initiatives, with up to 50% travel within the Northeast region and beyond.

Qualifications

• Experience with providers, health plans, value-based care organizations.
• Experience with provider contracting or network development.
• Data-driven mindset to translate insights into actionable initiatives.
• Ability to lead difficult conversations on utilization patterns and performance opportunities.
• Proven track record driving adoption, behavior change, and measurable results.
• Strong skills in strategy, analytics, and relationship management.

Responsibilities

• Serve as liaison between Network Performance and specialist providers to drive optimization.
• Develop contracts for specialist and ancillary providers to support network build-out.
• Build trusted relationships with providers to improve quality, access, and cost.
• Lead data-driven discussions on utilization trends, referrals, and practice variation.
• Identify barriers to outpatient utilization and implement efficiency strategies.
• Monitor provider adoption of changes and assess impact.
• Use analytics insights to prioritize outreach and measure interventions.
• Track KPIs like ASC utilization, outpatient migration, and cost savings.
• Provide leadership feedback on performance trends and opportunities.
• Collaborate with Analytics, Clinical, and Network Performance teams on optimization.
• Identify opportunities for value-based arrangements and rate negotiations.
• Support strategies to improve network efficiency and outcomes.

Skills

Provider relationships

Utilization management

Network performance

Data-driven insights

Contracting

Rate negotiation

Network development

Job description

The Specialist Navigator at Clover Health serves as the primary liaison between Clover's Network Performance team and specialist providers, translating data-driven insights into action to improve quality, access, affordability, and network outcomes.

You will develop and maintain relationships with providers, negotiate contracts, monitor utilization trends, and contribute to strategic network optimization initiatives, with up to 50% travel within the Northeast region and beyond.