Medical Director, Utilization Management

Clover Health is seeking a Medical Director, Utilization Management to evaluate referrals and inpatient admissions for medical appropriateness, leveraging local and national Medicare coverage determinations and company policies. The role involves ensuring member quality of life by providing personalized, patient-centered care and facilitating clinical guidelines development. Success in this role is measured by meeting productivity targets, maintaining accuracy, and proactively improving utilization management processes.

Requirements

• MD or DO degree
• Board Certification in Internal Medicine, Family Medicine, or related field
• Valid, unrestricted medical license in US state
• Minimum of five years of clinical experience
• One year of experience as a Utilization Management reviewer
• Medicare Advantage experience

Benefits

• Financial Well-Being
• Physical Well-Being
• Mental Well-Being
• Professional Development
• Employee Stock Purchase Plan
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remote-first culture
• Paid parental leave