Senior Manager, Network Operations

Summary

Join Clover Health as a Senior Manager, Network Operations, and play a key role in managing and optimizing network operational processes. This role focuses on project managing critical network operations tasks, including provider contract ingestion, maintaining the provider CRM solution, and strategic network performance analysis. You will collaborate with internal and external stakeholders to improve the provider experience. The ideal candidate has deep Medicare Advantage operations understanding, strong leadership skills, and excels in problem-solving and stakeholder management. This is an excellent opportunity for an experienced project manager with healthcare network operations knowledge. Success will be measured by improved provider experience, operational efficiency, and regulatory compliance.

Requirements

• You have 7+ years of experience in Medicare Advantage or healthcare plan operations or audit, with ideally at least 3 years in a managerial or leadership role
• You are proficient in software systems (e.g., salesforce, google suite, etc.)
• You have comprehensive knowledge of CMS regulations and Medicare Advantage compliance requirements
• You demonstrate strong project management, problem-solving, and decision-making abilities
• You demonstrate excellent verbal and written communication and presentation skills with the ability to communicate complex concepts across multiple disciplines
• You have training and talent development experience
• You have experience in cross-functional stakeholder and vendor management

Responsibilities

• Oversee the day-to-day execution of optimizing network operational processes
• Develop, implement, and refine operational processes and workflows to improve provider onboarding experience
• Project manage numerous strategic in-house projects designed to drive improved management and oversight of Network Operations
• Monitor and interpret CMS regulatory changes impacting Medicare Advantage plans, ensuring network operations reflect current requirements
• Work with compliance and legal teams to address any discrepancies and maintain adherence to federal and state regulations
• Coordinate with Provider Data Management, Credentialing, Configuration, and Network Contracting and Management to facilitate a best of class provider onboarding experience
• Act as the primary contact between BPaaS partner and Network to support problem-solving and issue resolution
• Manage vendor relationships and third-party partnerships to ensure compliance and service delivery standards are met
• Collaborate cross-functionally with operational, regulatory, and quality teams to ensure Network Operations aligns with Clover Health’s overall strategic goals and compliance requirements
• Identify and implement process improvements to streamline provider contract ingestion, enhance quality control, and drive an improved provider onboarding experience
• Drive the development and integration of automated solutions to improve efficiency and accuracy in plan configuration
• Monitor and respond to provider feedback and challenges, resolving issues quickly and ensuring a positive experience for our partners
• Supervise and mentor a team, fostering a culture of excellence, accountability, and continuous learning
• Develop and maintain documentation, training materials, and best practices for configuration procedures
• Assist Network Contract & Management team with analysis of network performance metrics and leverage data to identify opportunities for optimization and cost-effectiveness

Benefits

• 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
• We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage
• 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
• Developing internal talent is a priority for Clover
• We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews
• 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