Director, Network Performance

The Clover Care Services organization delivers proactive support and care to our members through our clinical Clover Home Care teams, and quality improvement services to our aligned providers through our Managed Care Organization. Clover has built one of the most proactive, data-driven health care services platforms and is excited about how technology impacts our ability to bring transformative results to both patients and providers.

The Director, Provider Network is a strategic, data-driven leader who manages Clover’s  provider contracting team in New Jersey. In this role you will partner with the VP of Network Performance to oversee the design, execution, and optimization of Clover’s provider network strategy across all markets in New Jersey, ensuring CMS and state regulatory requirements are met, cost efficiency, and superior member and provider experience.

Although this role is remote we are looking for someone in the NYC/NJ Metro area who has worked in and understands this market.

You will lead a high-impact team responsible for contracting, network adequacy, out-of-network cost management, Single Case Agreements (SCAs), and provider intake. You will balance strategy and execution, thrive in a fast-moving environment, and build scalable processes that meet both regulatory and operational needs.

As a Director, Network Performance, you will:

• Lead the development and execution of Clover’s provider network strategy in New Jersey, including maintaining network adequacy and coverage, advancing strategic growth, and directing data-driven reviews and action plans across all specialties.
• Establish and execute on an annual contracting roadmap aligned with affordability, access, and quality goals.
• Lead a team to deliver high-quality and data-driven contracting operations for PCP, specialist, ancillary and hospital entities.
• Oversee provider contracting activities, including new agreements, renegotiations, amendments, and escalations.
• Ensure CMS and state network adequacy compliance.
• Serve as the escalation point for complex provider negotiations, rate exceptions, and redline decisions.
• Implement contracting governance, including contract lifecycle management.
• Partner with Legal, Finance, Compliance, UM, and Claims to ensure operational readiness and consistency across all provider agreements.
• Ensure analytics are accurate, repeatable, and used to drive contracting priorities.
• Own provider intake governance and decision-making, and establish and monitor team SLAs for contracting throughput. 
• Create and deliver Network dashboards for leadership, including key progress points, major initiatives, adequacy status, contracting pipeline and/or OON savings.
• Drive continuous improvement across workflows, documentation, and provider experience.

Success in this role looks like:

• High provider satisfaction, measured through responsiveness, issue resolution, and clear communication.
• Network adequacy across all contracted counties.
• Clear, documented workflows and strong SLA performance across intake, contracting, renegotiations and adequacy.
• Accountability and execution of contracting across all specialities and entity types. 

You should get in touch if:

• You have a Bachelor’s Degree (strongly preferred)
• You have 8+ years of provider contracting experience, with direct responsibility for hospitals, large groups, and ancillary providers.
• You have 5+ years leading a network contracting team for a large entity. 
• goaidataanalyticsproductdesign