Clover is reinventing health insurance by working to keep people healthier.

Clover is a Medicare Advantage plan working to develop deeper insights to drive better outcomes for our members through our integrated technology platform. We rely on our abilities to integrate standard health plan data (eligibility, provider network, claims, authorizations, etc.) with clinical information from provider health information systems.

Clover Health Remote
Mar 20, 2021
Physician
We’re looking to hire a Utilization Management Medical Director to support our growing operations. This role will be a full-time position (40 hours weekly) responsible for the evaluation of all outpatient referrals for Part B Step Therapy Reviews as well as some inpatient reviews for  medical appropriateness. The physician will utilize Local and National Medicare Coverage Determinations, Milliman Care Criteria, Clover Health’s medical policies reviews, and Step Therapy Guidance to determine medical necessity or if an alternate treatment plan is required for our members. Clover Health’s Medical Management Committee provides oversight of the utilization review process and ensures that all decisions comply with accepted standards for determination of medical necessity. As a Utilization Management Medical Director, you will: Participate and support the Clover Health Utilization Management processes. Evaluate outpatient referral requests and...