Clover Health

4 weeks ago

Director, Network Operations

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 12 hours agoStatus: Live

Job Summary

AI-forward, executive leader responsible for architecting and directing Clover Health’s Provider Data Management ecosystem, credentialing workflows, and network adequacy models. Drives data integrity at scale, oversees remote teams, partners with vendors, and integrates AI/LLMs to automate provider data updates while ensuring CMS/NQCA compliance and a high-quality provider network.

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Executive & General Management

Seniority: Director level

Key Responsibilities

•Oversee the end-to-end Provider Data Management (PDM) platform and drive data-driven improvements to ensure high-fidelity provider data.
•Own the credentialing operations, including NCQA/compliance review and vendor coordination to support a robust Credentialing Committee.
•Establish and measure data-driven performance metrics for third-party credentialing vendors and BPaaS partners, aligning external workflows with internal goals.
•Lead integration of AI and LLMs to automate manual provider data updates and optimize validation pipelines.
•Manage and scale a fully remote network operations team, fostering accountability, technical fluency, and precision.

Pay and Benefits

Salary: USD 150,000 - 195,000 annually

Equity and Bonus:Equity

Perks:401kEquityRemote WorkCell PhonePaid ParentalLearning Budget

Key Requirements

•8+ years of executive leadership experience within healthcare network operations, provider data management, or credentialing, with emphasis on Medicare Advantage
•Deep SME in Provider Data Management (PDM) with proven ability to transform complex data infrastructures into automated systems
•Strong understanding of CMS network adequacy regulations, provider directory compliance mandates, and NCQA credentialing standards
•Extensive experience managing 3rd-party credentialing vendors and BPaaS partners to strict performance standards
•AI- and data-forward leadership with experience or mastery in building automated data pipelines and applying AI/LLM tools to provider data workflows

Experience:8+ yearsHealthcareMedicare AdvantageProvider data managementPDMCredentialing

Skills:LeadershipStrategic thinkingStakeholder managementData governanceVendor management

Languages:English

Tech Stack:AILLMsNPPESCAQHWeb scrapingData warehouseAPIsSQLPython

Company Brief

Clover Health

Clover Health is a technology-driven health insurance company offering Medicare Advantage plans that combine clinical care coordination, data analytics, and value-based care to improve outcomes and reduce costs for seniors.

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: Jersey City, United States

Founded: 2014

Website LinkedIn

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Clover Health

4 weeks ago

Director, Network Operations

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 12 hours agoStatus: Live

Job Summary

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Executive & General Management

Seniority: Director level

Key Responsibilities

•Oversee the end-to-end Provider Data Management (PDM) platform and drive data-driven improvements to ensure high-fidelity provider data.
•Own the credentialing operations, including NCQA/compliance review and vendor coordination to support a robust Credentialing Committee.
•Establish and measure data-driven performance metrics for third-party credentialing vendors and BPaaS partners, aligning external workflows with internal goals.
•Lead integration of AI and LLMs to automate manual provider data updates and optimize validation pipelines.
•Manage and scale a fully remote network operations team, fostering accountability, technical fluency, and precision.

Pay and Benefits

Salary: USD 150,000 - 195,000 annually

Equity and Bonus:Equity

Perks:401kEquityRemote WorkCell PhonePaid ParentalLearning Budget

Key Requirements

•8+ years of executive leadership experience within healthcare network operations, provider data management, or credentialing, with emphasis on Medicare Advantage
•Deep SME in Provider Data Management (PDM) with proven ability to transform complex data infrastructures into automated systems
•Strong understanding of CMS network adequacy regulations, provider directory compliance mandates, and NCQA credentialing standards
•Extensive experience managing 3rd-party credentialing vendors and BPaaS partners to strict performance standards
•AI- and data-forward leadership with experience or mastery in building automated data pipelines and applying AI/LLM tools to provider data workflows

Experience:8+ yearsHealthcareMedicare AdvantageProvider data managementPDMCredentialing

Skills:LeadershipStrategic thinkingStakeholder managementData governanceVendor management

Languages:English

Tech Stack:AILLMsNPPESCAQHWeb scrapingData warehouseAPIsSQLPython

Company Brief

Clover Health

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: Jersey City, United States

Founded: 2014

Website LinkedIn