Clover Health - Director, Network Operations

• 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 the end of your initial 90-day period: • 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. • Continued success: • 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. • 8+ years of executive leadership experience • 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. • deep Subject Matter Expert in Provider Data Management (PDM) • 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. • 3rd party credentialing vendors and BPaaS partners • 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. • AI- and data-forward • PDM "Golden Record" • You have a proven track record of successfully managing, scaling, and maintaining culture within fully remote teams. • 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. • cross-functional influence • You are a data-focused leader who builds strategy based on sophisticated dashboards and trend analysis.