Manager, Value-Based Care

At Clover Health we bring high-quality affordable and easy-to-understand healthcare plans to Americas seniors. We focus on preventive care and leverage data and technology from the Clover Assistant to empower physicians to make the best health recommendations based on our members complete health historyall with the lowest cost and the highest value.

The Medicare Advantage Finance Operations team is a collaborative detail-oriented group committed to continuous improvement. We partner closely across functions combining analytical rigor and strong teamwork to solve complex challenges and support the financial health of the Medicare Advantage program.

The Manager Value-Based Care will lead initiatives to design implement and optimize value-based payment models. They will drive provider performance through data-driven Joint Operating Committees and play a key role in shaping Clovers value-based strategy in partnership with internal and external stakeholders. This role is critical to Clovers mission of improving every life by enabling smarter healthcare and will be instrumental in operationalizing and scaling value-based care initiatives across our provider network.

As a Manager of Value-Based Care you will:

• Build Scalable Payment Operations
• Design and implement scalable and repeatable processes to support timely accurate payments to providers under existing and future value-based care models.
• Leverage automation and technology to streamline operations and improve efficiency accuracy and transparency.
• Partner with Clovers Finance Engineering and Claims teams to build robust infrastructure and tooling for value-based care payments.
• Provider Collaboration & Performance Management
• Facilitate and lead recurring Joint Operating Committee (JOC) meetings with Clovers Management Services Organization (MSO) ensuring alignment on clinical and financial performance objectives.
• Track performance against shared goals identify improvement opportunities and drive accountability through data-driven discussions.
• Build trusted relationships with partners across lines of business serving as a key operational liaison.
• Strategic Model Development
• Serve as a strategic thought partner across Clovers cross-functional teams to continuously evolve our approach to value-based care.
• Support the design of innovative payment models that align incentives and improve patient outcomes.
• Stay current on regulatory industry and market trends to inform Clovers strategy.

Success in this role looks like:

• By the end of your 90-day period you will have seamlessly integrated into the MA Finance Operations team and established strong working relationships with key MA (Finance Network Claims Engineering) and non-MA (MSO Counterpart Health) stakeholders. You will have developed a deep understanding of Clovers existing value-based care models payment operations and the data supporting Joint Operating Committee (JOC) meetings and will be actively participating in these discussions.
• By 6 months you will be fully immersed in the role independently leading JOC meetings and driving data-driven performance conversations with cross-functional partners. You will have identified key opportunities for process improvement and will be actively partnering with MA and MSO teams to design and implement more scalable automated payment operations.
• Future success in this role will be measured by your impact on the efficiency and effectiveness of our value-based care initiatives. This will be demonstrated through the successful implementation of optimized payment models improved provider performance against clinical and financial goals and your strategic contributions to the evolution of Clovers overall value-based care strategy.

You should get in touch if:

• You have 5 years of experience in healthcare operations value-based care provider strategy finance or a related field; experience in Medicare Advantage is strongly preferred.
• You have a strong understanding of value-based care models (e.g. capitation shared savings risk adjustment) and the operational implications of provider contracting and reimbursement.
• You have a Bachelors degree in business health administration finance or related field required; advanced degree (MBA MHA MPH) a plus.
• You have proven ability to lead cross-functional initiatives and manage complex stakeholder relationships.
• You have experience working directly with provider organizations MSOs or payers in a collaborative capacity.
• You have strong analytical skills with a data-driven mindset; proficiency in Excel required; SQL or similar data tools a plus.
• You have excellent communication skills with the ability to lead effective meetings and synthesize complex information clearly.
• You are comfortable working in a fast-paced ambiguous environment with a proactive and solutions-oriented approach.

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 weve 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 Clovers 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 peoples lives. Diversity not only includes race and gender identity but also age disability status veteran status sexual orientation religion and many other parts of ones identity. All of our employees points of view are key to our success and inclusion is everyones responsibility.

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Pursuant to the San Francisco Fair Chance Ordinance we will consider for employment qualified applicants with arrest and conviction records.We are anE-Verify company.

A reasonable estimate of the base salary range for this role is $125000 to $150000. Final pay is based on several factors including but not limited to internal equity market data and the applicants education work experience certifications etc.

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