Clover Health · 4 hours ago
Medical Director, Utilization Management (Part Time - Weekends)
United States
Full-time, Part-time
Remote
Mid, Senior Level
5+ years expClover Health is committed to providing high-quality, affordable healthcare plans for America’s seniors. The Medical Director, Utilization Management, will evaluate outpatient referrals and inpatient admissions for medical appropriateness, utilizing coverage determinations and medical policies to ensure necessary treatment for members.
Health CareHealth InsuranceHospitalMedical
Responsibilities
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
Provides clear and concise rationales for medical decisions, adhering to regulatory and compliance standards
Sustained high performance in productivity, accuracy, and adherence to medical policies and guidelines
Proactive identification of opportunities to improve utilization management processes and patient outcomes
Mentorship and support of junior medical directors or clinical staff
Contribution to the development and refinement of medical policies and clinical programs
Ongoing professional development and maintenance of medical licensure and board certifications
Positive feedback from internal and external stakeholders regarding clinical judgment and collaboration
Qualification
Required
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
Competitive base salary and equity opportunities
Performance-based bonus program
401k matching
Regular compensation reviews
Comprehensive medical, dental, and vision coverage
No-Meeting Fridays
Monthly company holidays
Access to mental health resources
Generous flexible time-off policy
Learning programs
Mentorship
Professional development funding
Regular performance feedback and reviews
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
Company
Clover Health
Clover is a healthcare technology company helping members live their healthiest lives with its Medicare Advantage plans.
501-1000 employees
Funding
Current Stage
Public CompanyTotal Funding
$1.62BKey Investors
GreenoaksSequoia CapitalFirst Round Capital
2021-11-17Post Ipo Equity· $300M
2021-01-08Post Ipo Equity· $400M
2021-01-08IPO
Leadership Team
Andrew Toy
Chief Executive Officer and Board Member (NASDAQ : CLOV)
Jamie Reynoso
Chief Executive Officer
Recent News
Fierce Healthcare
2026-01-19
2026-01-16
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