Specialist Navigator

Location: Field - New Jersey At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most. The Specialist Navigator sits at the intersection of provider relationships, utilization management, and network performance. This role is the primary liaison between Clover's Network Performance team and specialist providers, responsible for translating data-driven insights into meaningful provider action—improving quality, access, affordability, and network outcomes. This role requires up to 50% travel, primarily within New Jersey and Pennsylvania, with some travel to South Carolina and Georgia. As a Specialist Navigator, you will: Serve as the primary liaison between Network Performance and specialist providers, driving the Specialist Optimization Initiative and ensuring opportunities identified through analytics are translated into provider action and measurable performance improvement. Partner with Network Performance to develop contracts for specialist and ancillary providers that support the build-out of an efficient, high-performing network. Develop and maintain trusted relationships with specialist providers, positioning Clover as a collaborative partner focused on improving quality, access, affordability, and network performance. Lead data-driven discussions with providers regarding utilization trends, referral patterns, site-of-service opportunities, and practice variation. Partner with specialists to identify barriers to outpatient utilization and implement strategies that increase the effectiveness and efficiencies when clinically appropriate. Educate and support providers by discussing scheduling behaviors to support network optimization goals while maintaining quality outcomes and member access. Monitor provider adoption of recommended practice changes and assess shifts in referral behavior following engagement efforts. Leverage reporting and insights developed by the analytics team to identify utilization opportunities, prioritize provider outreach, and measure intervention effectiveness. Track, analyze, and report key performance indicators not limited to ASC utilization rates, outpatient migration trends, provider engagement activity, provider conversion and adoption rates, network performance improvements, and estimated and realized cost savings. Provide ongoing feedback to leadership regarding provider performance trends, emerging opportunities, and areas requiring intervention. Collaborate with Analytics, Clinical, and Network Performance teams to support strategic network optimization initiatives. Partner with the Network Performance team to identify opportunities for value-based arrangements, strategic rate negotiations, and specialist network enhancements. Support the development and execution of strategies that improve specialist network efficiency, affordability, and member outcomes. Success in this role looks like: Reduction in avoidable hospital outpatient department utilization where clinically appropriate Improved visibility into specialist utilization patterns and referral behavior Stronger provider engagement, alignment, and partnership across targeted specialist networks Measurable financial savings and improved medical cost performance driven by provider behavior change and network optimization initiatives Enhanced provider accountability through performance monitoring and data-driven engagement Expansion of the network through the addition of high-efficiency ambulatory surgical centers (ASCs), along with ongoing review of existing specialist providers—adding or terminating relationships as needed to maintain network quality and efficiency. You should get in touch if: You reside in New Jersey or within the tristate area with the ability to travel up to 50%. You have experience working with providers, health plans, value-based care organizations, or healthcare consulting teams to improve performance outcomes. You have prior experience with provider contracting, rate negotiation, or network development. You enjoy using data to uncover opportunities and are energized by turning insights into measurable operational change. You are confident in leading difficult conversations around utilization patterns, practice variation, and performance improvement opportunities. You have a track record of driving adoption, influencing behavior change, and achieving quantifiable results. You thrive in fast-paced environments where strategy, analytics, relationship management, and execution intersect. Benefits Overview : Financial Well-Being : 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. Physical Well-Being : We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare. Mental Well-Being : 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. Professional Development : Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews. Additional Perks: 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 And much more! 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, perspectives, opinions, 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. #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. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc. A reasonable estimate of the base salary range for this role is: $115,400 — $150,000 USD