Specialist Navigator

At Clover Health

At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most.

The Specialist Navigator sits at the intersection of provider relationships, utilization management, and network performance. This role is the primary liaison between Clover's Network Performance team and specialist providers, responsible for translating data-driven insights into meaningful provider action—improving quality, access, affordability, and network outcomes.

As a Specialist Navigator, you will:

• Serve as the primary liaison between Network Performance and specialist providers, driving the Specialist Optimization Initiative and ensuring opportunities identified through analytics 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 the 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 developed by the analytics team to identify utilization opportunities, prioritize provider outreach, and measure intervention effectiveness.
• Track, analyze, and report key performance indicators not limited to 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.

Success in this role looks like:

• Reduction in avoidable hospital outpatient department utilization where clinically appropriate
• Improved visibility into specialist utilization patterns and referral behavior
• Stronger provider engagement, alignment, and partnership across targeted specialist networks
• Measurable financial savings and improved medical cost performance driven by provider behavior change and network optimization initiatives
• Enhanced provider accountability through performance monitoring and data-driven engagement
• Expansion of the network through the addition of high-efficiency ambulatory surgical centers (ASCs)