Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Who Are We?
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values.
Why Join Us?
We're on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
Job Summary
The Senior Vice President, Provider Network Management is responsible for the enterprise-wide strategy, development, performance, and growth of the provider network. This role establishes and leads the long-term vision for provider partnerships across markets, ensuring the network strategy supports growth, access, quality, affordability, and value-based care objectives. Serves as the organization's senior executive on provider networks, directing provider development, contracting strategy, network adequacy, and provider relationship management.
Key Responsibilities
Enterprise Provider Network Strategy & Vision • Establish and lead the enterprise provider network strategy aligned with organizational growth, access, quality, and value-based care goals. • Define network design principles across primary care, specialty, hospital, ancillary, and delegated provider models. • Ensure network strategies anticipate regulatory, competitive, and market dynamics. • Serve as executive advisor to senior leadership on provider network planning and evolution.
Provider Development & Relationship Management • Lead physician, provider group, IPA, and health system relationship strategy. • Build and maintain long-term provider partnerships that support growth and retention. • Oversee provider onboarding, alignment, and relationship management frameworks. • Represent the organization with key external provider stakeholders.
Contracting, Value-Based Care & Network Economics • Oversee provider contracting strategy, including value-based and risk-based arrangements. • Guide contract structures, reimbursement models, and incentive alignment. • Lead analysis of utilization trends, reimbursement benchmarks, and market economics. • Support network-related due diligence for expansion and partnerships.
Network Operations, Performance & Compliance • Ensure network adequacy, access standards, and regulatory compliance across markets. • Oversee performance monitoring related to access, cost, quality, and growth. • Establish governance, policies, and operational standards for network management. • Drive continuous improvement through data-driven insights.
Leadership, Talent Development & Cross-Functional Partnership • Lead and develop provider network management leaders and teams. • Build a high-performing and accountable organization. • Partner with Sales, Marketing, Finance, Medical Management, and Product leaders to enable enterprise goals. • Champion innovation and change within provider network strategy and operations.
Qualifications
Education & Experience • Bachelor's degree in Business, Healthcare Administration, or related field required. • Master's degree (MBA, MHA) or equivalent experience preferred. • 10+ years of provider network development and contracting experience. • 5+ years of value-based care or risk-based contracting experience. • Medicare Advantage experience strongly preferred.
Skills & Competencies
• Executive presence with ability to influence senior leaders. • Deep expertise in provider contracting and value-based care models. • Strong strategic and execution capabilities. • Exceptional relationship-building and negotiation skills. • Ability to lead in highly matrixed environments.
Wage Range: $229,000 to $292,000 per year
Physical & Working Environment
Ability to travel as needed. Work performed in office and/or remote environment. Standard physical requirements associated with executive office roles. Must be located in Los Angeles or Orange County
Clever Care Health Plan
Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate's state residency.
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