Specialist Navigator

About the role

At Clover Health, the Specialist Navigator serves as the primary liaison between the Network Performance team and specialist providers, translating data‑driven insights into provider action to improve quality, access, affordability, and network outcomes. This role involves up to 50% travel, primarily within New Jersey and Pennsylvania, with some travel to South Carolina and Georgia.

Responsibilities

• Serve as the primary liaison between Network Performance and specialist providers, driving the Specialist Optimization Initiative and ensuring analytics‑identified opportunities 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 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 from the analytics team to identify utilization opportunities, prioritize provider outreach, and measure intervention effectiveness.
• Track, analyze, and report key performance indicators including 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.

Requirements

• Experience working with providers, health plans, value‑based care organizations, or healthcare consulting teams to improve performance outcomes.
• Prior experience with provider contracting, rate negotiation, or network development.
• Enjoy using data to uncover opportunities and are energized by turning insights into measurable operational change.
• Confident in leading difficult conversations around utilization patterns, practice variation, and performance improvement opportunities.
• Track record of driving adoption, influencing behavior change, and achieving quantifiable results.
• Thrive in fast‑paced environments where strategy, analytics, relationship management, and execution intersect.

Benefits

• Competitive base salary and equity opportunities.
• Performance‑based bonus program.
• 401k matching.
• Regular compensation reviews.
• Comprehensive medical, dental, and vision coverage.
• No‑Meeting Fridays.
• Monthly company holidays.
• Access to mental health resources.
• Generous flexible time‑off policy.
• Remote‑first culture supporting collaboration and flexibility.
• Learning programs and mentorship.
• Professional development funding.
• Regular performance feedback and reviews.
• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities.
• Reimbursement for office setup expenses.
• Monthly cell phone & internet stipend.
• Paid parental leave for all new parents.

Pay

A reasonable estimate of the base salary range for this role is: $115,400—$150,000 USD

Schedule

This role requires up to 50% travel, primarily within New Jersey and Pennsylvania, with some travel to South Carolina and Georgia.