C

Clover Health

Medicare Advantage insurer with personalized care

General Manager - Pharmacy

Full-Time
$317k - $375k
Expert
New Jersey, USA
HybridFrequent, meaningful on-site presence in New Jersey is required.
Business & Strategy

About the job

Requirements
  • Demonstrated experience launching a pharmacy or comparable regulated dispensing operation or program from concept through go-live.
  • Experience leading a dispensing, specialty, mail-order, rare-disease, oncology, or digital pharmacy business through material scale, transition, or transformation.
  • Experience owning a P&L or clear accountability for the performance of a substantial business line, not only a single function.
  • Ability to set strategy, build an organization, and manage through other leaders while remaining hands-on when required.
  • Knowledge of pharmacy operations, licensing, fulfillment, workflow, automation, quality, and provider engagement sufficient to make integrated business decisions.
  • Experience operating successfully in a regulated, metrics-rich environment and balancing growth, economics, member experience, and compliance.
  • Ability to travel frequently to New Jersey and establish credibility with on-site teams.
Responsibilities
  • Own the pharmacy P&L, annual operating plan, capital priorities, and a balanced scorecard spanning quality, growth, service, and financial performance.
  • Own the end-to-end pharmacy build, assembling the internal team and selecting and managing external partners for facilities, technology, licensing, fulfillment, and launch as appropriate.
  • Design and launch the pharmacy operating model, converting a fact-based assessment into a practical operating plan and clear accountabilities.
  • Set the long-term business strategy and scaling roadmap, including capacity, facilities, licensing, technology, automation, staffing, and organizational design.
  • Build and lead a high-performing management team, including the Pharmacist-in-Charge and pharmacy operations leadership; clarify decision rights between enterprise leadership and daily floor management.
  • Establish an operating cadence and metrics across prescription volume and capture, unit economics, turnaround time, quality, compliance, member experience, and workforce performance.
  • Drive pharmacy growth across Clover's Medicare Advantage membership through provider engagement, referral pathways, and a consistently strong member experience.
  • Oversee licensing, credentialing, regulatory readiness, and operational compliance through appropriately qualified leaders and partners.
  • Strengthen relationships with wholesalers, manufacturers, technology vendors, and other strategic partners.
  • Partner with Pharmacy Strategy, Clinical leadership, and the Part D Stars Strategy & Care Initiatives team to execute adherence interventions and improve member outcomes without owning Clover's overall Part D strategy.
  • Identify opportunities to extend the platform's capabilities and serve additional populations over time.
  • Establish an approved build plan, budget, leadership and partner model, regulatory critical path, and launch milestones within the first 90 days.
  • Align leaders on the operating plan, key performance indicators, and a sequenced 12- to 18-month scaling roadmap within the first 90 days.
  • Deliver measurable progress against quality, service, productivity, growth, and financial priorities within the first 6 months.
  • Strengthen provider referral and member-engagement infrastructure within the first 6 months.
  • Advance the facilities, systems, automation, staffing, and licensing work required for the next stage of scale within the first 6 months.
  • Build a durable management cadence and a leadership team capable of running the operation without dependence on the General Manager for daily floor decisions within the first 6 months.
  • Deliver profitable, compliant growth and increase prescription capture among Clover members.
  • Build a scalable, resilient dispensing platform with strong quality and member outcomes.
  • Establish the pharmacy as a strategic asset that supports Clover's broader care model and long-term growth.
Desired Qualifications
  • Experience in an integrated payer, provider, and pharmacy environment, or in business integration, transition, and scaling.

About the company

Clover Health provides Medicare Advantage plans for seniors in the United States, offering coverage that goes beyond traditional Medicare. Its services include personalized care, fitness memberships, home checkups, drug coverage, and Medigap insurance, with revenue coming from member premiums and Medicare reimbursements. The product works by enrolling members in Medicare Advantage and delivering added benefits through a network of healthcare providers and fitness centers, plus home visits and proactive support to manage health. The company differentiates itself with a focus on tailored, attentive care and a growing provider network to enhance member benefits, aiming to improve health outcomes. Its primary goal is to help seniors stay healthier and reduce out-of-pocket costs by combining comprehensive coverage with personalized services.

Company Size

501-1,000

Company Stage

IPO

Headquarters

Nashville, Tennessee

Founded

2014

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Simplify's Take

What believers are saying

  • Q2 2026 revenue reached $743.2 million, up 55.6%, with $41 million adjusted EBITDA.
  • Clover ended Q2 2026 with $443 million cash and no debt.
  • All members sit in 4.5-star plans for 2027, supporting bonus payments.

What critics are saying

  • CMS appealed Clover’s stars ruling on July 21, 2026; Eleventh Circuit briefing continues.
  • A reversal would erase roughly $120 million in bonus payments and pressure 2027 profits.
  • Medicare Advantage depends on CMS ratings; losing 4.5 stars would damage Clover’s growth story.

What makes Clover Health unique

  • Clover Assistant drives point-of-care recommendations across Medicare Advantage and Counterpart Health.
  • Clover’s wide-network PPO plans earned a 4.72 HEDIS score for 2027.
  • Counterpart Health extends Clover’s AI platform beyond members through Kno2 interoperability.

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Benefits

  • Health Insurance
  • Dental Insurance
  • Vision Insurance
  • 401(k) Company Match
  • Performance Bonus
  • Unlimited Paid Time Off
  • Remote Work Options
  • Parental Leave
  • Professional Development Budget
  • Phone/Internet Stipend

Growth & Insights and Company News

Headcount

6 month growth

0%

1 year growth

0%

2 year growth

0%
Yahoo Finance
Oct 9th, 2026
Clover Health's profit hinges on member retention as nearly half joined in 2025-26

Clover Health Investments reported that nearly half of its Medicare Advantage members joined in 2025 or 2026, a concentration that affects profitability. The company typically earns about $70 more gross profit per member monthly during their second year compared to their first. During the second quarter of fiscal 2026, membership grew 48% year-over-year to an average of 157,000. The 2026 cohort represents approximately 28% of total members, whilst the 2025 cohort accounts for about 21%. Management attributed this growth to disruption in core markets, including New Jersey. Second-quarter gross profit rose 54%, outpacing membership growth, though revenue still increased faster at 56%. The company raised full-year guidance but cautioned it wants to see more claims data before confirming trends will continue.

Bank Info Security
Sep 28th, 2026
Astrana Health tells SEC hack exposed sensitive data.

Astrana Health tells SEC hack exposed sensitive data. Social Engineering Attack Potentially Compromised Patient, Provider, Corporate Data Marianne Kolbasuk McGee (HealthInfoSec) - September 28, 2026 California-based Astrana Health has informed the U.S. Securities and Exchange Commission that a recent hack involving a social engineering campaign against the managed services organization affected a wide variety of sensitive and confidential data that might have been stolen. Astrana in a filing on Wednesday said it recently detected unusual activity in its IT environment. The company didn't disclose the date. "The incident involved a series of social engineering attempts in which threat actors, impersonating company personnel and spoofing the company's main corporate telephone number, contacted certain employees in an effort to obtain unauthorized access to company systems," Astrana told the SEC. Astrana's cybersecurity team responded to the activity, launched an investigation, engaged third-party cybersecurity and digital forensics experts, and notified law enforcement, as well as partners and state and federal regulators, the company said. Astrana said it has also taken remedial actions, including resetting affected credentials, restricting remote access tools, restoring certain systems from clean backups and enhancing monitoring, logging and detection capabilities across its environment. While Astrana's investigation into the hack is ongoing, so far the company said it believes some private and confidential information maintained on its servers was accessed or exfiltrated. Astrana is assessing whether patient, employee, credentialed providers, business and financial information, intellectual property and other information was affected. "While the investigation is ongoing, the company has determined that the incident is material as of Sept. 22, due to the potential confidential and sensitive nature of the data that is involved," Astrana told the SEC. Astrana also said that it still doesn't know the full impact of the incident on "business strategy, operations, financial condition or results of operations, including remediation and response costs, legal, regulatory and notification-related matters, and possible effects on providers, patients, counterparties and the company's reputation, or the impact on the trading price of the company's common stock." But the company said it doesn't expect the hack to affect the company's financial condition or operations. While Astrana said it has cyber insurance that may cover some losses related to the hack, "there can be no assurance that such coverage will be sufficient to cover all losses the company may incur," the filing says. Astrana, which reported total revenue of nearly $3.2 billion in 2025, describes itself on its website as a management services organization comprised of healthcare professionals and more than 600 employee associates. The company provides "comprehensive administrative support and various auxiliary services." As of Friday, no specific threat actor group had yet appeared to claim responsibility on the darkweb for the hack on Astrana. Astrana did not immediately respond to ISMG's request for comment and additional details about the incident. The attack on Astrana is among the latest recent social engineering and phishing hacks reported in recent months to the SEC by large publicly traded healthcare sector companies. Others include an attack reported to the SEC in June by Clover Health, a provider of Medicare Advantage health plans and a vendor of artificial intelligence-enabled clinical decision support tools for physicians. Also, Pennsylvania-based AdaptHealth, a home medical equipment supplier, in July reported a social engineering attack that compromised patient data. AdaptHealth reported the incident to the U.S. Department of Health and Human Services in August as a HIPAA breach affecting more than 4.1 million people (see: Breach Roundup: China Calls for Stronger AI Oversight).

DistilInfo
Sep 25th, 2026
Clover Health adds Torricelli, Miller to board.

Clover Health adds Torricelli, Miller to board. Former U.S. Sen. Robert Torricelli, D-N.J., and Brian Miller, MD, have been appointed to Clover Health's board of directors, confirming the Clover Health Torricelli Miller board additions announced Sept. 24. What these Clover Health Torricelli Miller board roles will involve. Torricelli will serve on Clover's audit committee, while Miller will be on the clinical committee. This division of committee assignments reflects each new director's distinct background, financial and policy expertise for Torricelli, clinical and Medicare payment policy expertise for Miller. Torricelli's background before this Clover Health board appointment. Torricelli has been a director of Clover's insurance subsidiaries since 2022. He founded business strategy firm Rosemont Associates in 2002 and real estate development firm Woodrose Properties in 2003. He was also executive vice president and COO of healthcare services company Aveta, giving him direct prior healthcare industry operational experience beyond his political and business background. Miller's background behind this Clover Health Torricelli Miller board appointment. Miller is an associate professor at Baltimore-based Johns Hopkins University and has practiced at Johns Hopkins Hospital. Since May 2023, he has been a commissioner on the Medicare Payment Advisory Commission, an agency that advises Congress on Medicare. He has also been on the board of trustees for the North Carolina State Health Plan since January 2025 and became vice chairman in April 2026. Why Miller's federal policy background stands out. Previously, Miller held roles at CMS, the FDA, and federal commissions, giving him direct experience across multiple federal health regulatory and payment bodies. This combination of active MedPAC commissioner status alongside prior CMS and FDA experience positions Miller to bring current, firsthand insight into Medicare payment policy debates directly into Clover's boardroom. Leadership's statement on this Clover Health Torricelli Miller board appointment. "Bob brings deep ties to New Jersey communities, experience navigating federal policy and firsthand knowledge of Clover," Clover CEO Andrew Toy said in the news release. "Brian combines clinical experience with a national perspective on Medicare payment and technology policy. His insights will help us advance care that improves quality, operates more efficiently and generates meaningful savings." Why this combination of directors fits Clover's strategic needs. Toy's framing suggests the two appointments were chosen to complement each other: Torricelli's regional and organizational familiarity with Clover paired with Miller's national Medicare payment and technology policy perspective, potentially strengthening the board's ability to navigate both local market dynamics and evolving federal reimbursement policy simultaneously. How this fits Clover's broader board composition. Clover's board now has nine directors, with the appointments filling two vacancies. This board expansion follows Chelsea Clinton's earlier departure from Clover Health's board, meaning these two new directors are specifically replacing the resulting openings rather than representing a net increase in board size beyond its prior full complement. Why filling these vacancies with this specific expertise matters. Choosing a former senator with existing Clover subsidiary board experience and an active MedPAC commissioner with federal regulatory experience to fill these two vacancies suggests Clover prioritized candidates who could immediately contribute both organizational continuity and current Medicare policy expertise, rather than seeking entirely new outside perspectives. What this Clover Health Torricelli Miller board appointment means going forward. With Miller's active role on MedPAC, the federal commission that advises Congress on Medicare payment policy, Clover Health gains a board member with direct, current insight into the federal policy discussions shaping Medicare Advantage reimbursement, potentially valuable given Clover's business as a Medicare Advantage-focused insurer. Given Torricelli's existing tenure on Clover's insurance subsidiary boards since 2022, his elevation to the parent company board level reflects continuity in governance rather than the introduction of an entirely unfamiliar director. What to watch going forward. As Torricelli and Miller settle into their respective audit and clinical committee roles, industry observers will likely watch whether Miller's MedPAC perspective visibly shapes Clover's approach to Medicare Advantage payment strategy and quality initiatives. Given the broader context of significant executive and board transitions across the payer industry this year, this Clover Health Torricelli Miller board appointment adds to a pattern of insurers seeking directors with direct federal health policy experience as Medicare Advantage reimbursement and regulatory scrutiny continue intensifying industrywide.

Associated Press
Sep 24th, 2026
Clover Health appoints former US Senator and MedPAC Commissioner to board

Clover Health has appointed former US Senator Robert Torricelli and Dr Brian J. Miller to its board of directors, filling two vacant positions and bringing the board to nine directors. Senator Torricelli will serve on the audit committee, whilst Dr Miller will join the clinical committee. Torricelli represented New Jersey in Congress for 20 years and has served on Clover's insurance subsidiary board since 2022. Dr Miller is a practising hospitalist at Johns Hopkins Hospital and currently serves as a commissioner on the Medicare Payment Advisory Commission. Chief executive Andrew Toy said the appointments strengthen the board with expertise spanning public service, Medicare Advantage, clinical practice and healthcare policy. The company operates a physician enablement technology platform and provides Medicare Advantage plans across several US states.

GlobeNewswire
Sep 24th, 2026
Clover Health welcomes former U.S. Senator Robert Torricelli and medpac Commissioner Dr. Brian J. Miller M.D. to its Board of Directors.

Clover Health welcomes former U.S. Senator Robert Torricelli and medpac Commissioner Dr. Brian J. Miller M.D. to its Board of Directors. WILMINGTON, Del., Sept. 24, 2026 (GLOBE NEWSWIRE) - Clover Health Investments, Corp. (Nasdaq: CLOV) ("Clover," "Clover Health" or the "Company") today announced the appointments of former U.S. Senator Robert Torricelli and Dr. Brian J. Miller, M.D., M.B.A., M.P.H., to the Company's Board of Directors, effective immediately. The appointments bring together two accomplished leaders whose complementary experience spans public service, Medicare Advantage, clinical practice, healthcare policy, and business. Senator Torricelli will serve on the Board's Audit Committee, and Dr. Miller will serve on its Clinical Committee. The appointments fill the Board's two previously disclosed vacancies and bring the Board to nine directors. "Today marks an exciting step forward for Clover, and we are thrilled to welcome Bob and Brian to our Board," said Andrew Toy, Chief Executive Officer of Clover Health. "Bob brings deep ties to New Jersey communities, experience navigating federal policy, and firsthand knowledge of Clover. Brian combines clinical experience with a national perspective on Medicare payment and technology policy. His insights will help us advance care that improves quality, operates more efficiently, and generates meaningful savings. Together, their experience, judgment, and perspectives will strengthen our Board and reinforce our ability to execute with discipline, grow responsibly, and build lasting value for our members, physicians, and shareholders." "From the beginning, we built Clover around the belief that some of the hardest problems in healthcare can be solved by challenging long-held assumptions about how healthcare works and care is delivered," added Vivek Garipalli, Co-founder of Clover Health and Executive Chairperson of the Board. "As Clover grows, it is important that our Board continues to reflect the complexity of the healthcare system we are working to improve and brings together special individuals who understand it from fundamentally different vantage points. Bob and Brian add tremendous depth across public policy, medicine, Medicare and business, and their perspectives will be invaluable as we drive forward on Clover's mission to Improve Every Life." Senator Torricelli brings a distinctive combination of deep New Jersey roots, national policymaking experience, and firsthand knowledge of Clover. For 20 years, he represented New Jersey in the U.S. House of Representatives and the U.S. Senate, where his committee service included the Senate Finance Committee and work on federal financing for healthcare institutions. Following his congressional career, he founded Rosemont Associates, a business strategy firm, and established Woodrose Properties, a real estate development business. Since 2022, he has served on the board of the Company's insurance subsidiaries, giving him firsthand familiarity with Clover's business, mission, and approach to Medicare Advantage. Additionally, Senator Torricelli has served as a director of Glassbridge Enterprises, Inc. since February 2017 and previously served as executive vice president and chief operating officer of Aveta, Inc., a healthcare services company. His experience navigating complex policy and business issues will bring a valuable perspective to Clover's Board and Audit Committee. "Through my years living in New Jersey and representing its communities in Congress, I have come to know the challenges many seniors face in accessing high-quality, affordable care," said Senator Torricelli. "Through my service on Clover's insurance subsidiary board, I have seen the Company's commitment to meeting those challenges with an ambitious vision and a practical, technology-driven approach. I am honored to join the Board and excited to contribute to its oversight, support this talented team, and help Clover build lasting value for members and shareholders." Dr. Miller brings a rare combination of frontline clinical practice and national Medicare policy leadership. A practicing hospitalist at the Johns Hopkins Hospital, an Associate Professor of Medicine at the Johns Hopkins University School of Medicine and Visiting Fellow at the Hoover Institution, Dr. Miller brings to Clover broad ranging regulatory experience spanning the Centers for Medicare & Medicaid Services, the U.S. Food and Drug Administration, and the Federal Trade Commission. He currently serves as Vice Chairman of the Board of Trustees for the North Carolina State Health Plan and as a Commissioner on the Medicare Payment Advisory Commission (MedPAC), the independent, nonpartisan commission that advises Congress on Medicare payment policy. Board-certified in internal medicine and preventive medicine, Dr. Miller offers a practical perspective on improving care delivery and advancing a more effective Medicare program. "As a practicing physician, I see every day how much better technology can support clinical practice when it delivers the right information at the point of care," said Dr. Miller. "Medicare needs models that can improve both convenience and quality for consumers, increase efficiency, and generate savings without adding burden for physicians or patients. Clover is building a differentiated model for Medicare Advantage: flexible and nimble, powered by technology, and close enough to physicians and patients to translate innovation into action. I am delighted to join the Board and look forward to helping Clover advance this approach and deliver a better care experience for people on Medicare." About Clover Health Clover Health (Nasdaq: CLOV) is a physician enablement technology company committed to bringing access to great healthcare to everyone on Medicare. This includes a focus on seniors who have historically lacked access to affordable, high-quality healthcare. Our strategy is powered by our software platform, Clover Assistant, which is designed to aggregate patient data from across the healthcare ecosystem to support clinical decision-making and improve health outcomes through the early identification and management of chronic disease. For our members, we provide PPO and HMO Medicare Advantage plans in several states, with a differentiated focus on our flagship wide-network, high-choice PPO plans. For healthcare providers outside Clover Health's Medicare Advantage plan, we extend the benefits of our data-driven technology platform to a wider audience via our subsidiary, Counterpart Health, and aim to enable enhanced patient outcomes and reduced healthcare costs on a nationwide scale. Clover Health has published data demonstrating the technology's impact on Medication Adherence, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, and in Underserved Populations as well as the earlier identification and management of Diabetes and Chronic Kidney Disease.