Network Engagement Manager
Clover Health, Philadelphia, PA
Clover is a Medicare Plan done differently.
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.
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 dynamic 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 finding opportunities to improve networks, offerings, and contracts.
- Handle contract implementations and assess 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 achievements are met.
You will love this job if:
- You are an experienced 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 positive relationships with many different types of people, teams, and partners.
- 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.
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.
Clover Health welcomes qualified candidates with disabilities and will provide accommodations during the interview process as needed. If you require accommodations, please email [email protected] with the details of your requested accommodation. Requests are reviewed by a member of the recruiting team. Requests will have no bearing on the candidate evaluation process or hiring decisions.
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.
Want to learn more about Clover Health? Visit Clover Health's website.
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