Clover Health

• Deliver preventive care to Clover members remotely via Clover’s proprietary software platform as well as approved third party video apps. • Complete a comprehensive review and assessment of a member's medical history, physical health, environment and psycho-social status. • Document progress notes, prepare member workups and encounter summaries using Clover Assistant and EMR. • Help at-risk members transition from the hospital and other facilities to their own home. • Create personalized care plans in coordination with the member's primary care physician. • Actively close gaps in care, which may include ordering labs, writing prescriptions with collaboration of the Primary Care Provider or collaborating physician, and coordinating physician follow up. • Perform point of care labs and diagnostic testing, such as A1c, spirometry, and other tests as applicable. • Activities will support Clover Care Visit program goals including accurate documentation of member health conditions, high performance on federal quality measures, and successful referral to network providers and internal Clover clinical teams to improve care and outcomes. • Completed visits include member specific AthenaNet and Clover Assistant (CA) visit documentation completed, electronically signed and closed according to Clover policy: • All AthenaNet visit documentation tabs completed according to visit type. • All applicable orders, referrals, gaps in care, PCP Letter, Follow up visit sections and Clinical Inbox and care coordination tasks are completed. • Visit specific CPT codes added in AthenaNet Billing Tab. • All CA visit tasks addressed, signed and autoloaded to AthenaNet visit. • Coordinate and communicate with members’ interdisciplinary care teams. • Participate in ongoing training and meetings remotely. • Comply with all Clover Care Service policies, procedures, standards of care and workflows. • Perform other duties as assigned.

• Review Home Health prior authorization requests for medical necessity using CMS regulations, the Medicare Benefit Policy Manual, and Clover clinical guidelines • Perform initial and concurrent clinical reviews for Home Health services • Ensure timely completion of utilization management reviews in accordance with CMS requirements and Clover policies • Collaborate with home health agencies, physicians, case managers, and internal care management teams to obtain clinical documentation • Identify opportunities to optimize care plans while promoting appropriate utilization of Home Health services • Apply sound clinical judgment and critical thinking to support evidence-based decision-making • Maintain accurate and timely documentation within utilization management platforms and electronic medical records • Build collaborative relationships with provider partners to facilitate timely authorizations • Maintain productivity and quality while managing multiple priorities in a fast-paced remote environment • Participate in quality improvement initiatives and ongoing education related to CMS regulations

• Build and maintain strong relationships with suppliers and serve as a primary point of contact for vendor inquiries, renewals, and procurement requests. • Partner with cross-functional stakeholders including IT, HR, Finance, Marketing, Operations, and Legal to support procurement initiatives and business needs. • Manage contract renewals and assist with sourcing, supplier selection, and procurement activities. • Negotiate pricing, payment terms, and other commercial terms for vendor contracts. • Contract review activities, including reviewing commercial terms, identifying risks, and assisting with basic contract redlining in accordance with Procurement and Legal contracting standards. • Collaborate with cross-functional workstream approvers to facilitate contract review, approval, and execution processes. • Maintain supplier, contract, and procurement records within the contract lifecycle management system. • Ensure compliance with procurement policies, approval requirements, signatory and contracting processes. • Support spend analysis, reporting, and continuous improvement initiatives across the procurement function.

• Design and champion internal Quality Programmes: Drive engineering-wide process changes and ensure pods adopt new reliability standards without friction. You will operate with a product-owner mindset to define and evangelize the internal reliability roadmap. • Define and enforce hard metrics: Measure and establish hard quality telemetry (e.g., DORA metrics, bug-to-deploy ratios, SLIs/SLOs) to create a quantifiable baseline for platform reliability. • Architect Shift-Left Pipeline Gates: Weave automated Performance, Security, and Accessibility checks directly into the CI/CD pipeline at the PR level in tight partnership with Eng Core. • Build Real-World Load Testing: Shift load and performance testing left for every customer onboarding, validating real-world assumptions. • Engineer Synthetic Data & Production Canaries: Build the architecture for safe synthetic data injection to unblock heavy load-testing and live-production canaries, strictly isolating test data from authentic user telemetry. • Leverage Generative AI Tooling: Actively utilize AI assistants (e.g., Gemini, Claude, Cursor, Codex) to accelerate the development of testing frameworks, automate infrastructure code, and design advanced testing architectures. • Drive Tooling Consolidation: Lead the technical migration away from expensive, legacy testing infrastructure to a unified, AI-supported automation stack. • Help define and maintain development practices: Enable fast iteration while ensuring quality, including writing tests and documenting key implementations.

• Investigate Suspected Fraud End-to-End: Own a portfolio of fraud investigations from intake through resolution. Develop investigative plans, gather and analyze evidence (including claims data, medical records, and provider documentation), interview witnesses where appropriate, and reach well-supported conclusions. • Handle Ad Hoc Internal Referrals: Take on investigations triggered by referrals from senior leaders and other internal stakeholders—e.g., a suspected provider outlier or a tip about potentially anomalous behavior—and provide a clear, factual assessment of whether something is amiss. • Coordinate Legal Support for Your Investigations: Work closely with Clover's attorneys to ensure each investigation has the legal guidance it needs. Identify legal questions early, route them to the right lawyer, and incorporate counsel's input into investigative strategy, documentation, referrals, and provider actions. • Build Defensible Documentation: Develop case files, memos, and referral packages that are factually complete, well-organized, and prepared with the evidentiary and procedural standards necessary for downstream enforcement, recoveries, or provider actions—working with Legal to confirm those standards are met. • Support Regulatory and Law Enforcement Referrals: Prepare referral packages for CMS, the MEDIC contractor, HHS-OIG, state fraud units, and law enforcement agencies, and coordinate with Legal on the form and substance of each referral. Track referral outcomes and help maintain relationships with enforcement partners. • Leverage Technology and AI: Partner with the VP of SIU and Clover's data science and engineering teams to evaluate, deploy, and refine AI-driven detection tools, predictive analytics, and data visualization platforms. Be a hands-on user and champion of technology in your own investigative work. • Collaborate Across Functions: Work with Clover's clinical, compliance, claims, payment integrity, provider relations, revenue operations, and SIU teams to gather information, validate findings, and translate investigative outcomes into operational improvements, provider education, and member impact. • Communicate Findings Clearly: Prepare concise written reports and oral briefings that translate complex investigative facts into clear narratives for senior leadership and other stakeholders.

• Own the white space. Operate with CEO mandate. Drive the programs that move the company. • Architect Strategic Programs: Translate high-level goals into MECE workstreams with clear interfaces, owners, and timelines. • Harness AI & Emerging Technology: Identify and deploy AI-powered tools and approaches to accelerate execution and unlock solutions across your own work and broader workstreams. • Drive Execution with CEO-Standard Rigor: Own initiatives from kickoff through outcomes. Set the pace. Maintain altitude and detail without losing either. • Align Stakeholders Across Levels and Functions: Influence without authority. Drive accountability through clarity, not escalation. • Translate Ambiguity Into Action: When no playbook exists, build one. When priorities are unclear, force rank them. When coordination breaks down, rebuild the system. • Collaborate Across Boundaries: Manage projects that touch internal teams and external partners — vendors, regulators, and strategic collaborators. Align internal readiness to external dependencies.

• Hold accountability for the accuracy, regulatory compliance (CMS), and publication of the consumer-facing Provider Directory, implementing strict controls to minimize data discrepancies. • Serve as the end-to-end owner of the PDM Platform. Champion the data architecture strategies required to ingest diverse API feeds (NPPES, CAQH, provider rosters, webscraping) into our data warehouse, applying weighted scoring and business rules to build a high-fidelity provider data environment. • Partner closely with the Chief Medical Officer (CMO), who chairs the committee, to own the end-to-end business operations of the enterprise Credentialing Committee. Ensure monthly meetings are executed seamlessly and that our third-party credentialing vendor arrives fully prepared with all necessary cases, files, and documentation for review in compliance with NCQA and regulatory standards. • Act as the primary lead for the strategic oversight of our third-party credentialing partners and BPaaS operational vendors. Establish rigorous data-driven performance metrics, hold partners to high operational standards, and seamlessly synchronize external workflows with internal goals. • Spearhead the integration of advanced AI and Large Language Models (LLMs) to automate manual provider data updates, optimize validation pipelines, and proactively identify directory inaccuracies. • Directly manage, mentor, and scale a highly skilled, fully remote network operations team, fostering an inclusive culture centered on accountability, technological fluency, and precision. • Provide the overarching strategic vision for network operations. Act as an executive unblocker, driving rapid, successful resolution to open, complex projects across Clinical, Claims, Product, Compliance, and Configuration teams.

• Provide clinical expertise support for Clover vendors and Medical Directors. • Create and assign inter-rater reliability reviews to RN reviewers and Medical Directors. • Complete monthly MD Quality Assurance (QA) reviews to ensure clinical compliance with Medicare regulations. • Service line clinical reviews. • Clinical Medical Record Review Subject Matter Expert (SME). • Identifying clinical opportunities for improvement and communicating to upper management. • Tracking clinical performance and evaluation of vendors medical reviewers. • Clinical support for new medical review process implementations. • Monitor and track CMS Medicare clinical updates that impact Clover clinical processes, partner with management to implement clinical changes. • Displays Flexibility to adjust work based on new challenges or feedback. • Clinical collaboration with cross-functional departments.

• Own the Interventions technical roadmap, driving the strategy for improved clinical data accuracy and the effective closure of clinical care gaps. • Lead the diagnostic precision strategy by optimizing assessment surfacing, implementing member-specific modeling, and advancing the extraction of high-quality evidence from clinical data sources. • Oversee the scaling of Interventions systems to accommodate a rapidly growing member base, including the core data infrastructure overhaul and ensuring ML pipeline stability through decoupling and improved QA environments. • Manage cross-functional partnerships with Clinical Operations, Product, and cross-functional teams’ leadership to ensure technical investments remove clinical bottlenecks and improve plan performance. • Drive the adoption of an AI-powered Software Development Life Cycle (SDLC), leveraging AI tools to accelerate coding, testing, and deployment processes while maintaining stringent code quality and security standards.

• Lead and grow our SRE team of ~10 engineers, including hiring, retention, career development, and performance management across multiple time zones (US, HK, NZ). • Build strategic partnerships with product engineering pillars — shifting SRE from reactive, ticket-based support to proactive co-ownership of reliability outcomes. • Scale our multi-tenant infrastructure to support new customer onboarding and growing patient populations. • Own cloud cost management and FinOps practices, building frameworks that balance cost control with reliability and performance. • Champion developer self-service and platform engineering. Build self-service capabilities so product teams can manage routine operations without filing SRE tickets. Establish SLOs/SLIs for critical services and improve alert quality so every page is meaningful. • Ensure the SRE team is fully leveraging AI tooling in their workflows — using tools like Claude Code for IaC generation, log analysis, root cause investigation, and automating repetitive work — at the same level as the rest of engineering.