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 Utilization Management (UM) team plays a vital role in supporting Clover members throughout their care journey. The team is made up of experienced clinicians who combine clinical expertise with data-driven insights to support evidence-based decision-making. Working closely with providers and care partners, the UM team ensures that care transitions are smooth, efficient, and always focused on improving member outcomes while maintaining compliance with CMS guidelines. As the Lead RN, Utilization Management, you will coach and develop clinical staff, oversee daily review operations, and monitor quality and vendor performance. You will partner with Medical Directors and teams across Clover to strengthen review consistency and improve workflows. The ideal candidate brings sound clinical judgment, strong leadership skills, and a commitment to putting members first. As a Lead RN, Utilization Management, you will: Lead, coach, and onboard Utilization Management nurses and clinical reviewers; use case audits and feedback to support staff development and accountability. Manage daily workloads, staffing coverage, and escalations across prospective, concurrent, and retrospective reviews. Ensure reviews and determinations are timely, accurate, well documented, and consistent with benefits, clinical criteria, regulatory requirements, and Clover policies. Partner with Medical Directors on complex cases, peer-to-peer reviews, and cases requiring physician review. Oversee vendor contracting, implementation, performance, and delegation; monitor trends, turnaround times, productivity, and quality, and implement corrective actions. Maintain UM policies, procedures, the prior authorization list, and job aids; improve workflows, automation, and the member and provider experience. Collaborate with Appeals and Grievances, Care Management, Claims, Provider Relations, Compliance, and Product; support regulatory audits, accreditation, and quality improvement. Success in this role looks like: You enjoy developing others and helping clinical teams deliver consistent, high-quality work. You use data to improve care operations and turn performance trends into practical solutions. You put members first and bring sound clinical judgment, clear communication, and collaboration to complex decisions. You should get in touch if: You hold an active, unrestricted RN license Bachelor of Science in Nursing or equivalent relevant experience. You have at least five years of clinical nursing experience and three years in health plan, managed care, or utilization management settings. You have experience leading, supervising, or mentoring clinical staff and strong coaching, communication, critical-thinking, and conflict-resolution skills. You understand medical-necessity review and clinical documentation, have applied InterQual or MCG criteria, and have working knowledge of Medicare Advantage and applicable CMS requirements. You can manage competing priorities and regulatory turnaround times and are proficient with clinical review platforms, electronic health records, and productivity tools. Preferred: A multistate or compact RN license; formal people-management experience in a health plan or managed care setting; and experience supporting Medicare Advantage members. Certification in case management, UM, or healthcare quality; experience with audits, accreditation, delegated vendor oversight, and performance improvement; and familiarity with value-based care and technology-enabled workflows. 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 an

This posting is for an existing vacancy. At Counterpart Health, we are transforming healthcare and improving patient care with our innovative primary care tool, Counterpart Assistant. By supporting Primary Care Physicians (PCPs), we are able to deliver improved outcomes to our patients at a lower cost through early diagnosis and longitudinal care management of chronic conditions. We are looking for a Senior Software Developer with expertise in full-stack engineering. In this role, you will collaborate with our operators, clinicians, and product managers to build tools that drive real change in healthcare. You won't just write code to spec — you'll understand the business problem, engage with stakeholders, and shape the solution. As a Senior Software Developer, you will: Simplify the complexities of healthcare by building systems that enhance human efforts. Understand the business context behind what you build — why it matters, who it serves, and how it connects to outcomes. Exercise agency: make informed technical and product decisions on your own to advance outcomes. Take ownership of your work from problem understanding through delivery and measurement. Stay up-to-date with new tools and technologies to solve challenges and advance our goals. Adopt and evangelize AI both in your own work and in the solutions you build. Help define and maintain development practices that enable fast iteration while ensuring quality, including writing tests and documenting key implementations. Collaborate with Product Managers and operational teams to conceptualize and develop new features. Engage directly with users and stakeholders to understand their needs — don't wait for requirements to be handed to you. You should get in touch if: You have 5+ years of experience in software with proficiency in one or more common languages, and are also familiar with various databases and web frontend technology. You know how to build systems with AI agents as your partners and team members, and are passionate about the impact AI can have in technology. You approach building and maintaining systems with maturity, rigor, and attention to scalability. You are comfortable working across different technical systems and concerns. You have experience building and refactoring complex (often distributed) systems. You care about outcomes, not just output. You want to understand the "why" behind what you build and can connect your work to business and user impact. We're hiring Software Developers across multiple teams at Clover and Counterpart Health— our recruiting team will assess your background and connect you with the best-fit opportunity. You'll learn more about the specific team and interview process as you move through the process. 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 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 offering comprehensive group medical coverage that include coverage for hospitalization, outpatient care, optical services, and dental benefits. 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, company holidays, access to mental health resources, and a generous annual leave policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location. Professional Development : We are committed to developing our talent professionally. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews. Additional Perks: Reimbursement for office setup expenses Flexibility to work from home, enabling collaboration with global teams Paid parental leave for all new parents And much more! About Counterpart Health: In 2018, Clover Health set out to do something unprecedented: build a clinically intuitive, AI-enabled solution that fits within physicians' workflows to help support the earlier diagnosis and management of chronic conditions. Years later, that vision is a reality, with thousands of practitioners using Counterpart Assistant during patient visits to improve disease management, reduce medical expenses, and drive success in value-based care. With an exceptional team of value-based care and technology experts, Counterpart Health is driving value-based care at the speed of software. Counterpart Health is a subsidiary of Clover Health. From Clover’s 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

The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clover's provider Network, Claims, and Tech teams. The Payment Integrity team ensures that Clover pays claims in an accurate manner, with a particular focus on reducing inappropriate medical spend. As an Inpatient Clinical Coder at Clover Health , you will play a key role ensuring that Clover is able to continue to build and scale a compliant, efficient and profitable program. You will work to ensure quality assurance standards and regulatory policy are reflected in claims processing practices. You will help drive value for every member by ensuring that Clover’s medical claims are paid accurately and recovering overpayments when they are identified. The Associate - Inpatient Coder coordinates the identification of provider DRG denials and upcoding. As an Inpatient Clinical Coder, you will: Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis that drive inaccurate payments to providers. Proactively identify overpayments to ensure accurate claims payments on inpatient services. Participate in collaborative discussions with MDs to verify the clinical rationale behind billed procedures. Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams. Communicate effectively both internally and externally to ensure accurate claims adjudication and proper provider notification. Success in this role looks like: By the end of your initial 90-day period, you will have demonstrated a strong understanding of clinical coding practices and medical records review, while assisting our team in areas of DRG validation. By 6 months, you will be working autonomously to execute within our clinical review workflows and will have developed strong interpersonal relationships across the organization. Continued success in this position anchors in on developing a deep understanding of the workflows that support our clinical review life cycle, while maintaining regulatory compliance standards. You should get in touch if: You hold a CCS or CIC certification; required. Knowledge of DRG pricing methodology; required. You have 1-2 years of experience in inpatient clinical coding; preferred Medicare or Medicare Advantage payment integrity or claims operations experience; preferred You are technologically savvy with strong computer skills in Excel and PowerPoint. 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 we've 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 Clover’s 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 people's lives. Diversity not only includes race and gender identity, but also age,

Counterpart Health is an AI‑powered physician enablement platform that delivers clinical insights to providers at the point of care. Our flagship product, Counterpart Assistant, is embedded into clinicians’ workflows and integrates with EHR systems, helping care teams drive value-based outcomes, close care gaps, and proactively manage chronic disease. As we grow our data ecosystem, expanding across legacy interoperability networks, QHIN/TEFCA connectivity, and direct HIE integrations, we need rigorous analytical ownership to ensure the clinical data powering our platform is complete, reliable, and actionable. You will serve as the Subject Matter Expert (SME) for clinical data completeness and effectiveness at Counterpart Health. Sitting within the Data Products pillar, this role owns the end-to-end understanding of our clinical data lifecycle: where data comes from, where it breaks down, and how each vendor or integration pathway performs across our customer markets. Your analysis will directly shape vendor strategy, facility targeting, and data pipeline investments, thus ensuring that the clinical evidence our care teams depend on is consistently available and trustworthy. As a Data Analyst, you will: Proactively identify and monitor which healthcare facilities consistently generate high-quality, usable clinical documents (e.g., EHRs, discharge summaries, procedure notes) to precisely locate and quantify data gaps. Conduct deep-dive analyses by mapping and correlating facility-specific data across disparate sources like structured claims, clinical care summaries (CCDAs), and ADT messages to uncover systematic patterns of missingness, latency, Experience with TEFCA/QHIN frameworks and evolving national interoperability standards. Familiarity with vendor-specific data exchange platforms (e.g., Bamboo Health, HSX, Particle Health, Kno2). Background in value-based care, population health, or clinical data operations. Experience with claims-clinical data reconciliation (e.g., matching EOBs to clinical encounter records). Comfort working with Python or similar tools for data manipulation and automation. or incongruence in clinical records. Establish and maintain clear, transparent reporting on ADT coverage across key geographic, organizational, and technological dimensions (e.g., by county, facility, and underlying EMR system). Based on rigorous analysis of data flow and quality, recommend and guide the implementation of optimal technical configurations for existing data vendors (e.g., Bamboo Health, PCC, Experian, HSX). Conduct comprehensive evaluations and proof-of-concepts for potential new data integration technologies (e.g., Kno2 vs. Particle Health) to assess viability, quality improvements, and strategic fit. Systematically determine the existence and completeness of documentation associated with specific patient visits or encounters. Develop a data-driven framework for prioritizing facility targets for direct data acquisition, assessing impact, cost-effectiveness, and technical feasibility. Inform and guide vendor strategy around national initiatives such as TEFCA and QHIN adoption, ensuring Counterpart Health is positioned for compliant, high-quality data exchange. Partner cross-functionally with Product Managers to define data requirements, Engineers to implement reliable pipelines, and Clinical teams to validate data quality and clinical utility. Act as a critical liaison to identify and remove operational and technical bottlenecks, ensuring a predictable, scalable, and reliable clinical data flow across all customer markets. You should get in touch if you have: 2+ years of hands-on data analytics experience, with direct exposure to healthcare data interoperability Strong hands-on experience with healthcare data standards: HL7, CCDA, and ADT messages. Proficiency in SQL and comfort working with large, complex datasets (claims, clinical logs, interoperability data). Background in analyzing interoperability networks (e.g., Carequality, CommonWell, eHealthExchange) or HIE integrations. Skilled at data visualization and able to present complex findings to both technical and non-technical stakeholders. Strong investigative mindset, i.e., you enjoy digging into the “why” behind missing data and diverging metrics. Self-directed and able to manage multiple analytical projects (vendor comparisons, visit-level reconciliation) without constant supervision. Preferred Qualifications: Experience with TEFCA/QHIN frameworks and evolving national interoperability standards. Familiarity with vendor-specific data exchange platforms (e.g., Bamboo Health, HSX, Particle Health, Kno2). Background in value-based care, population health, or clinical data operations. Experience with claims-clinical data reconciliation (e.g., matching EOBs to clinical encounter records). Comfort working with Python or similar tools for data manipulation and automation. Benefits Overview : Financial Well-Being : Our commitment to attracting and

The Clover Care Services organization delivers proactive support and care to our members through our clinical Clover Home Care teams, and quality improvement services to our aligned providers through our practice engagement team. Clover has built one of the most proactive, data-driven health care services platforms and is excited about how technology impacts our ability to bring transformative results to both patients and providers. Clover Care Services is entering a significant period of clinical growth. As we scale our Clover Care Visit (CCV) team, we need a dedicated leader who can turn an ambitious hiring plan into a reliable, repeatable workforce engine—from recruiting pipeline and onboarding capacity through clinician readiness, productivity, and performance. As the Director, Workforce Management , you will connect workforce planning, recruiting, onboarding, leadership capacity, and performance management into one operating system, giving the organization clear visibility into whether we are on pace and what needs to change when we are not. As Director, Workforce Management, you will: Own the CCV workforce plan end to end. Build and run the staffing strategy required to scale the clinician organization, translating long-range growth targets into weekly and monthly hiring, onboarding, and readiness goals. Create visibility from candidate pipeline to “ready to visit.” Establish the operating metrics, forecasting, and reporting needed to understand recruiting conversion, onboarding lead times, attrition, training capacity, and clinician readiness—and surface risks early enough to act. Build a scalable clinician onboarding model. Partner across Clinical, Talent, IT, Operations, and other teams to evolve today’s high-touch onboarding journey into a structured model that can support significantly larger hiring cohorts without sacrificing clinical quality. Build the leadership capacity required to scale. Determine the right model for preceptors, clinical leads, onboarding cohorts, and frontline management so that rapid growth does not create an unsustainable burden on existing clinical leaders. Own workforce performance management. Establish clear, actionable standards and operating rhythms across areas such as attendance, cancellation rates, Clover Assistant Touch, productivity, and normalized performance measures. Make quality and productivity work together. Build performance expectations that reflect accurate, sustainable clinical performance—not simply higher activity—and partner with clinical leaders to ensure workforce decisions support both member experience and quality of care. Turn workforce data into decisions. Build the dashboards, forecasts, and management routines leaders need to understand capacity, identify constraints, allocate resources, and stay ahead of hiring or performance gaps. Create repeatable workforce-management capabilities for CCS. Use the CCV ramp as the first proving ground for processes, tools, and operating models that can later support In-Home Care and other Clover Care Services programs. Operate as a cross-functional leader. Bring together Clinical Activation, clinical leadership, Talent, Operations, Finance, analytics, and other partners around one integrated workforce plan with clear owners, milestones, and escalation paths. Success in this role looks like: In your first 90 days, you will: Build a clear baseline of the CCV workforce funnel and translate the 2027 growth target into a measurable workforce plan spanning recruiting, onboarding, training capacity, clinician readiness, and attrition. Identify the biggest risks and bottlenecks in the ramp and establish the metrics, operating cadence, and accountability needed to address them. Within your first 6 months, you will: Establish a predictable recruiting-to-readiness operating model, including scalable onboarding cohorts, preceptor capacity, and clinical leadership support. Launch workforce dashboards and performance-management routines that enable leaders to anticipate capacity gaps, manage performance, and increase clinician onboarding volume without sacrificing quality. Over time, you will: Help CCV reach its clinician-capacity goals ahead of the 2027 AEP cycle through a sustainable, data-driven approach to hiring, onboarding, and performance. Build repeatable workforce-management capabilities that can extend beyond CCV to support In-Home Care and other Clover Care Services programs. You should get in touch if: You have built or led workforce planning, capacity management, clinical operations, field operations, or another complex people-scaling function where success depended on turning ambitious growth targets into an executable operating plan. You are comfortable owning the full workforce funnel—from recruiting demand and hiring pace through onboarding, readiness, productivity, performance, and attrition. You know how to scale a high-touch operating model without sacrificing the quality, judgment, and human support

Clover Health ’s People Operations team is the strategic force behind our human capital management. We attract and recruit top talent, manage employee lifecycle processes, and foster career development and continuous learning. We’re proud of our data-driven approach to talent engagement and feel privileged to support our global workforce. We are seeking a Director, Enterprise Initiatives & Enablement, to lead change management across employee-impacting initiatives and help our people understand, adopt, and sustain changes that improve how we work. Reporting to our Chief People Officer, you will connect enterprise priorities with the planning, communication, training, and follow-through needed to make employee-impacting initiatives successful. Your focus will be on internally facing change across technology, operations, policies, and ways of working, including initiatives with broader business implications. You will work across People Operations, technology and architecture, internal communications, business teams, and executive leadership. You will bring a clear view of the portfolio, surface dependencies and risks early, help teams make decisions, and stay engaged through adoption. As the work grows, this role may lead portfolio operations or initiative delivery staff. As a Director, Enterprise Portfolio Management, you will: Own a coherent view of major employee-impacting initiatives, including their priorities, owners, dependencies, timing, risks, and readiness for change. Design, build and apply AI to improve decision-making and operational efficiency while providing appropriate confidentiality, governance, and human oversight. Establish practical governance for intake, prioritization, status reporting, decisions, and escalation so leaders and delivery teams can act on the same information. Partner with technology, infrastructure, and architecture leaders to understand how system and process changes affect employees, and sequence work around business cadences and competing priorities. Lead change plans that cover stakeholder alignment, employee communications, training and retraining, launch readiness, adoption, and reinforcement. Translate complex technical, operational, or policy changes into clear messages and actions for the employees and leaders affected. Identify resistance, gaps in ownership, and other barriers to adoption early; bring the right partners together to resolve them and hold teams accountable through implementation. Coordinate with internal communications and People Operations on timely, relevant information, and support related people, operating, and organizational processes. Build trust across functions, navigate ambiguity and competing viewpoints, and give executives a clear account of progress, tradeoffs, and decisions needed. Success in this role looks like: Leaders have a clear, shared view of which initiatives matter most, how they are sequenced, and where decisions or support are needed. Stakeholders understand ownership, dependencies, milestones, and next steps, with risks and organizational readiness visible early. Employees receive useful, appropriately tailored communications and the training they need before and after changes launch. Major changes become part of how people work, with adoption and reinforcement continuing beyond initial delivery. Cross-functional teams work through competing priorities and follow through on commitments from planning to sustained use. You should get in touch if: 7+ years of experience leading enterprise portfolio management, cross-functional program delivery, technology change management, or internal operations work with meaningful employee impact. You are an experienced Operator, comfortable influencing without direct authority, navigating personalities, and holding stakeholders accountable. You have experience operating in a public company or regulated environment and understand the visibility, governance, and accountability it requires. You know how people absorb information, respond to change, and build new habits, and you can turn that understanding into effective communication and adoption plans. You communicate clearly with employees and executives, exercise sound judgment, discernment and influence stakeholders without relying on direct authority. You can connect strategy to hands-on execution, manage ambiguity and strong personalities, and keep complex work moving to completion. You bring a systems view and business acumen across technology, finance, operations, employees, and culture. Experience with technology, infrastructure, architecture, or enterprise systems change is preferred. 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 prioritiz