At Clover Health, we’re focused on improving the health of our members by leveraging technology and data-driven insights to provide personalized, high-quality care. As a Medicare Advantage plan, we aim to empower our members by helping them navigate the complexities of healthcare and live healthier lives. We are passionate about making healthcare easier, more affordable, and more accessible for everyone.
We are looking for an AI-forward Director of Network Operations to architect the strategic roadmap for our provider data ecosystem, credentialing frameworks, and network adequacy models. In this high-impact leadership role, you will champion a culture of "Data Integrity at Scale," serving as the enterprise authority on Provider Data Management (PDM)—which is a critical focus area for our organization.
While leading a high-performing remote workforce, you will act as the strategic bridge between advanced data platforms, external vendors, and internal operational areas. You will own the optimization of our PDM infrastructure, drive continuous improvement in directory accuracy, and provide rigorous oversight for our third-party credentialing and BPaaS partners. By engineering a highly reliable PDM experience, you will directly reduce provider friction and ensure our members interact with a compliant, highly accurate provider network.
As a Director, Network Operations, you will:
- Hold accountability for the accuracy, regulatory compliance (CMS), and publication of the consumer-facing Provider Directory, implementing strict controls to minimize data discrepancies.
- Serve as the end-to-end owner of the PDM Platform. Champion the data architecture strategies required to ingest diverse API feeds (NPPES, CAQH, provider rosters, webscraping) into our data warehouse, applying weighted scoring and business rules to build a high-fidelity provider data environment.
- Partner closely with the Chief Medical Officer (CMO), who chairs the committee, to own the end-to-end business operations of the enterprise Credentialing Committee. You will ensure monthly meetings are executed seamlessly and that our third-party credentialing vendor arrives fully prepared with all necessary cases, files, and documentation for review in compliance with NCQA and regulatory standards.
- Act as the primary lead for the strategic oversight of our third-party credentialing partners and BPaaS operational vendors. Establish rigorous data-driven performance metrics, hold partners to high operational standards, and seamlessly synchronize external workflows with internal goals.
- Spearhead the integration of advanced AI and Large Language Models (LLMs) to automate manual provider data updates, optimize validation pipelines, and proactively identify directory inaccuracies.
- Directly manage, mentor, and scale a highly skilled, fully remote network operations team, fostering an inclusive culture centered on accountability, technological fluency, and precision.
- Provide the overarching strategic vision for network operations. Act as an executive unblocker, driving rapid, successful resolution to open, complex projects across Clinical, Claims, Product, Compliance, and Configuration teams.
Success in this role looks like:
- By the end of your initial 90-day period: You will have gained foundational proficiency with our core credentialing, PDM, and network adequacy software platforms, alongside our foundational AI tools. You will have seamlessly integrated with your remote team and established trust-based, cross-functional relationships across the organization. Additionally, you will project manage the kickoff of a comprehensive directory quality audit, while simultaneously evaluating all current-state BAU operational processes to map out immediate opportunities for enhanced automation.
- By 6 months: You will have successfully completed the directory quality audit and implemented systemic data enhancements to deliver a tangibly improved directory experience. The architectural concept of the PDM "Golden Record" will be fully integrated into our overarching data management pipelines. While continuously maintaining robust, compliant processes around credentialing and network adequacy strategy, you will shift your focus to deploying AI oversight mechanics for ongoing directory reviews and automated data risk scoring.
- Continued success: You will position Clover as a market leader in directory reliability and network operations compliance. By championing automated monitoring, AI-driven data cleansing, and strict vendor accountability, you will transform the network operations department into a proactive, technologically sophisticated powerhouse.
You should get in touch if:
- You have 8+ years of executive leadership experience within healthcare network operations, provider data management, or credentialing, with a heavy emphasis on Medicare Advantage.
- You are a deep Subject Matter Expert in Provider Data Management (PDM), with a proven track record of transforming complex data infrastructures into highly efficient, automated systems.
- You possess a sophisticated understanding of CMS network adequacy regulations, provider directory compliance mandates, and NCQA credentialing standards.
- You have extensive experience managing and holding 3rd party credentialing vendors and BPaaS partners to strict performance and service level standards.
- You are exceptionally AI- and data-forward—you are passionate about deploying LLMs (Claude, Gemini, ChatGPT) and advanced technical solutions to replace manual workflows. Specifically, you have experience or conceptual mastery around building a PDM "Golden Record"—architecting automated data pipelines that ingest fragmented inputs (NPPES, CAQH, rosters, webscraping) into a data warehouse and applying algorithmic weighted averages to triangulate the true source-of-truth.
- You have a proven track record of successfully managing, scaling, and maintaining culture within fully remote teams.
- You are a master of cross-functional influence, capable of stepping into complex, multi-departmental environments to realign priorities and push stalled initiatives across the finish line.
- You are a data-focused leader who builds strategy based on sophisticated dashboards and trend analysis.
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.
