Medical Director, Utilization Management (Fully Remote)

Clover Health; United States; Remote; USD 180,000 - 240,000; Full time

Benefits offered by this job

Remote-first culture

Job summary

Clover Health is seeking a physician to lead and review utilization management activities in a remote-first environment with a focus on seniors' health. You will review medical necessity, authorize UM decisions, and mentor UM nurses while engaging in peer-to-peer discussions with providers to improve care and outcomes.

The role requires board-certified MD/DO with US license and at least five years of clinical experience plus UM review exposure.

Qualifications

• MD/DO with board certification and valid U.S. license.
• Five years clinical experience plus one year UM review experience.

Responsibilities

• Support utilization management processes and review authorizations for medical necessity.
• Perform peer-to-peer discussions with providers and mentor UM nurses.

Skills

Board certification

US license

Clinical experience

Education

MD/DO

Job description

• Support utilization management processes and review authorizations for medical necessity.
• Perform peer-to-peer discussions with providers and mentor UM nurses.

Qualifications:

• MD/DO with board certification and valid U.S. license.
• Five years clinical experience plus one year UM review experience.

About Clover:

• Data-driven health insurance focused on seniors.
• Remote-first, mission-driven, and collaborative team.

Clover Health

Clover Health is reinventing health insurance by combining data with human empathy to keep members healthier. It is a mission-driven company focused on providing high-quality, affordable healthcare for America's seniors.