Network Engagement Manager at Clover Health
Philadelphia, PA, US

Clover is reinventing health insurance by working to keep people healthier.

Clover Health is a Medicare Advantage and Prescription Drug plan that is changing how health care is delivered. The health care delivery system is undergoing many changes, however most health insurance payers are trying to execute this change with decades old processes and technologies in a top-down framework. In this role, you will have the opportunity to engage with forward thinking health systems with the goal of implementing programs in a data driven manner to improve the lives of our members and transform the health care delivery system.

You will be accountable for developing and executing the provider contracting and implementation strategy for a defined market. You will also be responsible for participating in the development of the network management strategy which includes aspects of technology product, utilization management, value-based care, membership growth, marketing, compliance, and member and provider experience.

Come be at the heart of progressive payer/provider relationships!

As a Network Engagement Manager, you will:

  • Be the face of Clover to market's healthcare providers and key industry stake-holders.
  • Organize physician engagement strategies to build unified care management and coordination programs.
  • Support Clover's physician alignment/incentive programming.
  • Provide strategic and operational leadership for network build and provider contracting initiatives; Analyze network gaps and identify providers to contract with.
  • Lead the negotiation of fee-for-service and value/risk-based performance provider contracts; Source and manage contracts for primary care, specialty physicians and ancillary providers .
  • Lead payor performance analysis by identifying opportunities to improve networks, offerings, and contracts.
  • Manage contract implementations and asses overall performance, aimed at improving overall value, outcomes and financial performance.
  • Address and resolve operational concerns raised by network providers.
  • Coordinate data transfer and feedback loops between physicians and Clover to ensure physician milestones are met.

You will love this job if:

  • You are an expert negotiator and able to create win-win scenarios.
  • You are passionate about transforming the health delivery through data driven analysis and development of new technologies.
  • You have an insatiable curiosity which feeds an appetite to learn and teach.
  • You want to make an impact. You thrive off of helping others and want your work to make a difference in our members' lives, while also advocating for their needs.
  • You are a people person - you know how to communicate effectively to build trust and lasting partnerships with many different types of people, teams, and stakeholders.
  • You are nimble, and comfortable working in a constantly evolving environment. You embrace ambiguity and speed while maintaining a bias towards action.

You should get in touch if:

  • You have an understanding of provider contract options, healthcare economics and competitors practices with the ability to grasp both clinical and business concepts.
  • You have strong analytical and quantitative background.
  • You know how to interpret fee-for-service and value-based program requirements and understand the impact on financial performance.
  • You have proven experience negotiating contracts to improve overall performance; flexing details quickly based on real-time conversations.
  • You are skilled in establishing and maintaining strategic relationships
  • You are able to create buy-in and drive action across a wide set of collaborative team members.
  • You have positive leadership skills and the ability to influence, collaborate and motivate others.
  • You have a great understanding of healthcare topics, such as claims processing, EHRs, medical billing and coding and physician reimbursement models.

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.