Director, Network Operations

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $150k - $195k / year

⏰ Full Time

🔴 Lead

🌐 Network Operations

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Clover Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Clover Health (Nasdaq: CLOV) is a physician enablement company focused on seniors who have historically lacked access to affordable, high-quality healthcareWe aim to provide great care, in a sustainable way, by having a business model built around improving medical outcomes while lowering avoidable costs. We do this while taking a holistic approach to understanding the health needs and social risk factors of those under our care. This strategy is underpinned by our proprietary software platform, the Clover Assistant, which is designed to aggregate patient data from across the health ecosystem to support clinical decision-making by presenting physicians and other providers with real-time, personalized recommendations at the point of care.Making care more accessible is at the heart of our business, and we believe patients should have the freedom to choose their doctors. We offer affordable Medicare Advantage plans with extensive benefits, provide primary care physicians with the Clover Assistant, and also make comprehensive home-based care available via the Clover Home Care program.With our corporate headquarters in Nashville, Clover’s workforce is distributed around the U.S. and also includes a team of world-class technologists based in Hong Kong. We manage care for Medicare Advantage members in Alabama, Arizona, Georgia, Mississippi, New Jersey, Pennsylvania, South Carolina, Tennessee, and Texas.We are hiring software engineers, data scientists, designers and product folks who can help us understand our members’ wellness and steer them clear of any health risks down the road.If you’re a passionate person and interested in changing healthcare for the better, then Clover Health may just be the place for you.

📋 Description

• Hold accountability for the accuracy, regulatory compliance (CMS), and publication of the consumer-facing Provider Directory, implementing strict controls to minimize data discrepancies. • Serve as the end-to-end owner of the PDM Platform. Champion the data architecture strategies required to ingest diverse API feeds (NPPES, CAQH, provider rosters, webscraping) into our data warehouse, applying weighted scoring and business rules to build a high-fidelity provider data environment. • Partner closely with the Chief Medical Officer (CMO), who chairs the committee, to own the end-to-end business operations of the enterprise Credentialing Committee. Ensure monthly meetings are executed seamlessly and that our third-party credentialing vendor arrives fully prepared with all necessary cases, files, and documentation for review in compliance with NCQA and regulatory standards. • Act as the primary lead for the strategic oversight of our third-party credentialing partners and BPaaS operational vendors. Establish rigorous data-driven performance metrics, hold partners to high operational standards, and seamlessly synchronize external workflows with internal goals. • Spearhead the integration of advanced AI and Large Language Models (LLMs) to automate manual provider data updates, optimize validation pipelines, and proactively identify directory inaccuracies. • Directly manage, mentor, and scale a highly skilled, fully remote network operations team, fostering an inclusive culture centered on accountability, technological fluency, and precision. • Provide the overarching strategic vision for network operations. Act as an executive unblocker, driving rapid, successful resolution to open, complex projects across Clinical, Claims, Product, Compliance, and Configuration teams.

🎯 Requirements

• 8+ years of executive leadership experience within healthcare network operations, provider data management, or credentialing, with a heavy emphasis on Medicare Advantage. • Deep Subject Matter Expert in Provider Data Management (PDM), with a proven track record of transforming complex data infrastructures into highly efficient, automated systems. • Sophisticated understanding of CMS network adequacy regulations, provider directory compliance mandates, and NCQA credentialing standards. • Extensive experience managing and holding 3rd party credentialing vendors and BPaaS partners to strict performance and service level standards. • Exceptionally AI- and data-forward—passionate about deploying LLMs (Claude, Gemini, ChatGPT) and advanced technical solutions to replace manual workflows. Specifically, experience or conceptual mastery around building a PDM "Golden Record"—architecting automated data pipelines that ingest fragmented inputs (NPPES, CAQH, rosters, webscraping) into a data warehouse and applying algorithmic weighted averages to triangulate the true source-of-truth. • Proven track record of successfully managing, scaling, and maintaining culture within fully remote teams. • Master of cross-functional influence, capable of stepping into complex, multi-departmental environments to realign priorities and push stalled initiatives across the finish line. • Data-focused leader who builds strategy based on sophisticated dashboards and trend analysis.

🏖️ Benefits

• 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!