Director, Network Operations
New
C
Clover HealthHealth Insurance
Remote - USAFull-TimeDirector
Salary$150,000 — $195,000 USD
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Job Details
- Experience
- 8+ years of executive leadership experience
- Required Skills
- Artificial IntelligenceLLM
Requirements
- 8+ years of executive leadership experience in healthcare network operations, provider data management, or credentialing.
- Deep expertise in Medicare Advantage.
- Sophisticated understanding of CMS network adequacy regulations and NCQA credentialing standards.
- Proven track record managing and holding third-party credentialing vendors and BPaaS partners to high performance standards.
- Experience with PDM 'Golden Record' concepts and architecting automated data pipelines using NPPES, CAQH, and webscraping.
- Experience deploying AI and LLMs (Claude, Gemini, ChatGPT) for workflow automation.
- Proven track record managing and scaling fully remote teams.
- Mastery of cross-functional influence in complex, multi-departmental environments.
- Data-focused leader capable of building strategy based on dashboards and trend analysis.
Responsibilities
- Ensure accuracy, regulatory compliance, and publication of the consumer-facing Provider Directory.
- Serve as end-to-end owner of the Provider Data Management (PDM) platform and data architecture.
- Partner with the Chief Medical Officer to manage the enterprise Credentialing Committee.
- Oversee third-party credentialing and BPaaS operational vendors by establishing performance metrics.
- Spearhead the integration of AI and Large Language Models to automate provider data updates.
- Manage, mentor, and scale a fully remote network operations team.
- Act as an executive unblocker for complex cross-functional projects across Clinical, Claims, and Product teams.
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