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Manager, Healthcare Management

Clover Health, United States

Clover is a Medicare Plan done differently.


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


We don't just provide health insurance—we deliver the kind of healthcare that people deserve. The Actuarial team at Clover is made up of collaborative and strategic thinkers that are excited about the impact technology can have on healthcare. We're looking for Actuaries who are interested in taking the actuarial discipline into the new era.

We’re looking for a Manager, Healthcare Management who is interested in enhancing Clover’s ability to evaluate key medical cost saving initiatives. In this role, you will partner with the various teams at Clover to maintain financial discipline and transparency when evaluating and negotiating partnerships with providers or outside vendors.

As a Manager, HCM, you will:

  • Collaborate with the Network, Clinical, and Strategy team to evaluate new health care management initiatives. Produce analyses to clearly understand the potential savings and ROI, and highlight which initiatives should be prioritized.
  • Serve as the financial lead when Clover negotiates contractual terms with vendors or providers with special contractual arrangements.
  • Forecast and monitor provider’s and vendor’s financial positions per contracted arrangements (e.g. shared savings arrangements), and calculate net savings achieved for Clover.
  • Track Clover’s Network unit price performance including: year-over-year contracted rate increases, composite percent of Medicare Fee Schedule for Facility and Professional claims, and high volume Out-of-Network providers.
  • Maintain and build lasting relationships with business partners across the organization.

You will love this job if:

  • You are prepared to collaborate with senior healthcare leaders who are on a mission to innovate healthcare for millions of lives across the country.
  • You are an effective leader across a diverse set of responsibilities and teams.
  • You are passionate about serving seniors through Original Medicare and Medicare Advantage.
  • You dream about ways to make the healthcare system more efficient. 
  • You are analytical and strategic and love working in a collaborative, transparent work environment.
  • You want to make an impact. From project scope to priority to implementation, you'll have an impact on how decisions get made.
  • You are great at communicating complex concepts to a non-technical audience.

You should get in touch if:

  • You have 5+ years of financial analyst experience in a health care setting, preferably with a payor or healthcare vendor.
  • You are an Associate or Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries.
  • You have basic programming skills, such as SQL, SAS, R, or Python.
  • You have advanced Excel skills and have a working knowledge of other Microsoft Office tools (Word, PowerPoint) and Google suite.
  • You have domain expertise in multiple of the following areas: Medicare (Part A & Part B)/Medicare Advantage, provider contracting, value based provider arrangements, medical and pharmacy claims data, and CMS data-sets.

#LI-Remote


Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.


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.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.


About Clover Health

Clover Health is a data driven health insurance startup driving to improve the overall state of healthcare in America. 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. Unlike other health insurance companies also embracing preventive health, Clover’s Medicare is built on technology from the ground-up. Integrating our systems with doctors, clinicians, and nurse practitioners, Clover’s data team helps healthcare professionals in the field intervene directly into patients’ wellness to help them avoid acute health episodes. If you’re a passionate person and interested in changing healthcare for the better, then Clover may just be the place for you.

Clover Health

Want to learn more about Clover Health? Visit Clover Health's website.