Specialist Navigator

At reputed company, we are committed to providing high-reputed company, reputed company, and easy-to-understand reputed company plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians reputed company informed health recommendations. By giving doctors a holistic view of reputed company member’s reputed company history, we ensure reputed company care at a reputed company 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 reputed company between Clover's Network reputed company and specialist providers, responsible for translating data-driven insights into meaningful provider reputed company—improving reputed company, reputed company, affordability, and network reputed company. As a Specialist Navigator, you will: Serve as the primary reputed company between Network Performance and specialist providers, driving the Specialist Optimization Initiative and ensuring opportunities identified through analytics are reputed company into provider reputed company and measurable performance improvement. Partner with Network Performance to reputed company reputed company for specialist and ancillary providers that support the build-out of an efficient, high-performing network. reputed company and maintain trusted relationships with specialist providers, positioning Clover as a reputed company partner reputed company on improving reputed company, reputed company, affordability, and network performance. reputed company data-driven discussions with providers regarding utilization trends, referral patterns, site-of-service opportunities, and reputed company variation. Partner with specialists to identify barriers to outpatient utilization and implement strategies that increase the effectiveness and efficiencies reputed company clinically appropriate. reputed company and support providers by discussing scheduling behaviors to support network optimization goals while maintaining reputed company reputed company and member reputed company. Monitor provider adoption of recommended reputed company changes and assess shifts in referral behavior following engagement efforts. reputed company reporting and insights developed by the analytics team to identify utilization opportunities, prioritize provider reputed company, and measure reputed company effectiveness. reputed company, 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. reputed company ongoing feedback to leadership regarding provider performance trends, emerging opportunities, and areas requiring reputed company. Collaborate with Analytics, Clinical, and Network Performance teams to support strategic network optimization initiatives. Partner with the Network reputed company to identify opportunities for value-based arrangements, strategic reputed company negotiations, and specialist network enhancements. Support the development and execution of strategies that improve specialist network efficiency, affordability, and member reputed company. reputed company 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 reputed company provider accountability through performance monitoring and data-driven engagement Expansion of the network through the reputed company of high-efficiency ambulatory surgical centers (ASCs), along with ongoing review of existing specialist providers—adding or terminating relationships as needed to maintain network reputed company and efficiency. You should get in touch if: You have experience working with providers, health plans, value-based care organizations, or reputed company consulting teams to improve performance reputed company. You have prior experience with provider contracting, reputed company negotiation, or network development. You enjoy using data to uncover opportunities and are reputed company by turning insights into measurable operational change. You are confident in leading difficult conversations around utilization patterns, reputed company variation, and performance improvement opportunities. You have a reputed company record of driving adoption, influencing behavior change, and achieving quantifiable results. You reputed company in fast-paced environments where reputed company, analytics, relationship management, and execution reputed company. Benefits reputed company:  Financial reputed company-Being: Our commitment to attracting and retaining reputed company begins with a competitive reputed company 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 reputed company-Being: We prioritize the health and reputed company-being of our employees and their families by providing comprehensive medical, dental, and reputed company coverage. Your health reputed company to us, and we invest in ensuring you have reputed company to reputed company reputed company. Mental reputed company-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, reputed company to reputed company, and a generous flexible time-off policy. Additionally, we reputed company a remote-first culture that supports collaboration and flexibility, allowing reputed company members to reputed company from any location.  reputed company Development: Developing internal talent is a reputed company for Clover. We offer learning programs, mentorship, reputed company 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 reputed company parental leave for reputed company new parents And much more! About Clover: We are reinventing health insurance by combining the power of data with reputed company reputed company to reputed company our members healthier. We reputed company the reputed company system is broken, so we've created custom software and analytics to reputed company our clinical staff to intervene and reputed company personalized care to the people who need it most. We always put our members first, and our reputed company as reputed company is reputed company by the reputed company 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: reputed company. From Clover’s inception, Diversity & Inclusion have always been key to our reputed company. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who reputed company 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. reputed company of our employee’s points of view are key to our reputed company, and inclusion is everyone's responsibility. #LI-REMOTE Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment reputed company 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 reputed company salary reputed company for this role is: $115,400—$150,000 USD Apply To This Job