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Clover is a healthcare technology company helping members live their healthiest lives with our Medicare Advantage plans.
Medical Director, Utilization Management – Part Time, Weekends
Location
United States
Posted
144 days ago
Salary
0
Seniority
Lead
Job Description
Medical Director, Utilization Management – Part Time, Weekends
Clover Health
• The Medical Director, Utilization Management, will be responsible for the evaluation of all outpatient referrals and inpatient direct admissions for medical appropriateness. • The physician will utilize Local and National Medicare Coverage Determinations, Milliman Care Criteria, Clover Health’s medical policies reviews to determine medical necessity or if an alternate treatment plan is required for our members. • Successfully completes all required new hire training modules and certifications • Demonstrates a foundational understanding of Clover Health's medical policies, guidelines, and utilization management processes • Begins to independently review cases with increasing efficiency and accuracy, requiring minimal oversight • Establishes positive working relationships with team members and key stakeholders • Consistently meets or exceeds productivity targets for case reviews and determinations • Maintains a high level of accuracy in medical necessity determinations and documentation • Actively participates in team meetings and contributes to process improvement discussions • Demonstrates a comprehensive understanding of complex medical cases and escalates issues appropriately.
Job Requirements
- You have an MD or DO degree.
- You have Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or a related specialty.
- You have a valid, unrestricted license to practice medicine in a U.S. state.
- You have a minimum of five years of clinical experience.
- You have at least one year of experience as a Utilization Management reviewer.
- You have Medicare Advantage experience.
- You are dedicated to improving members’ quality of life by providing superior, personalized, patient-centered care.
- You have a genuine interest in leveraging technology to help people and maintain a positive attitude toward tackling important industry challenges.
Benefits
- 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!
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