Specialist Network Navigator (Remote) — Provider Partnerships

Clover Health; Elm (PA); On-site; USD 115,000 - 150,000; Full time

Benefits offered by this job

Equity opportunities

Office setup reimbursement

Monthly cell phone & internet stipend

Remote-first culture

Paid parental leave

Job summary

Clover Health is seeking a Specialist Navigator to bridge Network Performance and specialist providers, translating analytics into actionable improvements in quality, access, affordability, and network outcomes.

The role requires up to 50% travel, mainly within New Jersey and Pennsylvania, with some travel to South Carolina and Georgia. You will lead negotiations, develop contracts, and drive provider engagement to optimize outpatient utilization and cost savings.

Qualifications

• Experience working with providers, health plans, value-based care organizations, or healthcare consulting teams to improve performance outcomes.
• Experience with provider contracting, rate negotiation, or network development.
• Ability to translate data-driven insights into actionable provider actions and measurable improvements.

Responsibilities

• Serve as the primary liaison between Network Performance and specialist providers, driving the Specialist Optimization Initiative and ensuring opportunities identified through analytics are translated into provider action and measurable performance improvement.
• Partner with Network Performance to develop contracts for specialist and ancillary providers that support the build-out of an efficient, high-performing network.
• Develop and maintain trusted relationships with specialist providers, positioning Clover as a collaborative partner focused on improving quality, access, affordability, and network performance.
• Lead data-driven discussions with providers regarding utilization trends, referral patterns, site-of-service opportunities, and practice variation.
• Partner with specialists to identify barriers to outpatient utilization and implement strategies that increase the effectiveness and efficiencies when clinically appropriate.
• Educate and support providers by discussing scheduling behaviors to support network optimization goals while maintaining quality outcomes and member access.
• Monitor provider adoption of recommended practice changes and assess shifts in referral behavior following engagement efforts.
• Leverage reporting and insights developed by the analytics team to identify utilization opportunities, prioritize provider outreach, and measure intervention effectiveness.
• Track, analyze, and report key performance indicators not limited to ASC utilization rates, outpatient migration trends, provider engagement activity, provider conversion and adoption rates, network performance improvements, and estimated and realized cost savings.
• Provide ongoing feedback to leadership regarding provider performance trends, emerging opportunities, and areas requiring intervention.
• Collaborate with Analytics, Clinical, and Network Performance teams to support strategic network optimization initiatives.
• Partner with the Network Performance team to identify opportunities for value-based arrangements, strategic rate negotiations, and specialist network enhancements.
• Support the development and execution of strategies that improve specialist network efficiency, affordability, and member outcomes.

Skills

Provider relationships

Utilization management

Network performance

Data analytics

Contracting

Stakeholder engagement

Job description

Clover Health is seeking a Specialist Navigator to bridge Network Performance and specialist providers, translating analytics into actionable improvements in quality, access, affordability, and network outcomes.

The role requires up to 50% travel, mainly within New Jersey and Pennsylvania, with some travel to South Carolina and Georgia. You will lead negotiations, develop contracts, and drive provider engagement to optimize outpatient utilization and cost savings.