Strategic Network Navigator (Remote)

Clover Health; Williamstown (NJ); Hybrid; USD 115,000 - 150,000; Full time

Benefits offered by this job

Employee stock purchase plan (ESPP)

Remote-first culture

Paid parental leave

Office setup reimbursement

Monthly cell phone & internet stipend

Flexible time-off policy

Job summary

Clover Health is seeking a Specialist Navigator to bridge Network Performance and specialist providers, translating analytics into concrete actions that improve quality, access, and affordability.

Travel is required up to 50% within NJ/PA, with additional trips to SC and GA. You will influence contracts, provider relationships, and network optimization to drive measurable outcomes while supporting a high-performing, patient-centered network.

Qualifications

• Experience working with providers, health plans, value-based care organizations to improve performance outcomes.
• Experience with provider contracting, rate negotiation, or network development.
• Track record of driving adoption and achieving quantifiable results.

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.

Job description

Clover Health is seeking a Specialist Navigator to bridge Network Performance and specialist providers, translating analytics into concrete actions that improve quality, access, and affordability.

Travel is required up to 50% within NJ/PA, with additional trips to SC and GA. You will influence contracts, provider relationships, and network optimization to drive measurable outcomes while supporting a high-performing, patient-centered network.