Lead Medical Director, Utilization Management (Fully Remote)

Clover Health; United States; Remote; USD 150,000 - 210,000; Full time

Benefits offered by this job

Equity

Bonus

401(k) match

Medical insurance

Dental insurance

Vision insurance

Flexible time-off

Parental leave

Job summary

Clover Health is seeking a Lead Utilization Management Medical Director in the United States. You will lead the UM team, review complex cases, and chair the Utilization Management Committee to drive evidence-based decisions.

The role partners with clinical and operational teams to maintain policies and improve quality, while evaluating outpatient referrals and inpatient admissions for medical appropriateness. Competitive compensation includes equity, bonus, and 401(k) match.

Responsibilities

• Lead a team, review complex cases, and chair the Utilization Management Committee.
• Partner with clinical and operational teams to maintain policies and improve quality.
• Evaluate outpatient referrals and inpatient admissions for medical appropriateness.

Job description

• Lead UM Medical Directors in making timely, evidence-based medical necessity decisions.
• Evaluate outpatient referrals and inpatient admissions for medical appropriateness.

Key Responsibilities:

• Manage a team, review complex cases, and chair the Utilization Management Committee.
• Partner with clinical and operational teams to maintain policies and improve quality.
• Competitive salary, equity, bonus, and 401(k) match.
• Comprehensive medical, dental, vision, flexible time-off, and parental leave.

Clover Health

Clover Health provides healthcare plans for America's seniors, using data and technology through the Clover Assistant to support physicians. The company is mission-driven and diverse, focused on improving members' lives through personalized care.