Medical Director, Behavioral Health

  • Clover Health
  • Remote
  • May 02, 2021
Physician Psychiatry

Job Description

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

We value diversity — in backgrounds and experiences. Healthcare is a universal concern, and we need people from all backgrounds and swaths of life to help build the future of healthcare.

Clover's UM team works to build & refine complex, highly-regulated processes in order to improve the health outcomes of our members.The Behavioral Health Medical Director provides operational leadership and is responsible for ensuring the clinical accuracy of all reconsiderations and payment disputes and reviewing and refining all IRE case narratives as applicable to behavioral health.

This position is remote and part-time (approximately 20 hours a week).

As a Behavioral Health Medical Director you will:

  • Perform individual case review for psychiatric admissions. Communicate with medical directors regarding appeals decision rationales, and benefit interpretations.
  • Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results.
  • Utilize MCG Criteria, CMS Guidelines, medical and administrative policies to evaluate medical necessity of requested service, applying sound clinical judgement.

You will love this job if:

  • You are empathetic and have excellent telephonic and interpersonal communication skills.
  • You thrive in a collaborative environment, working together being a part of a team and have strong team building skills.
  • You are service oriented — you feel fulfilled in helping and supporting others to achieve common goals while resolving issues while seeing opportunities to problem solve creatively.
  • You have an insatiable curiosity and appetite to learn the mechanics of complex systems - healthcare is especially intricate and highly regulated.
  • You are a self-starter who learns new tools quickly and has a keen eye to improve things.
  • You believe fiercely in the protection of our members.
  • You understand that compliance is not just a set of rules you follow, it's the way you work.

 You should get in touch if:

  • You are an MD or DO with an active, unrestricted license.
  • You have 5+ years Psychiatric clinical practice experience.
  • You have 2+ years of working experience in a managed care organization.
  • You have a minimum of 2+ years Medicare Advantage appeals experience.
  • You have experience with CMS guidelines, regulations, and audits.
  • You have Microsoft office or Mac computer skills including experience with typing, word processing, presentations, spreadsheet experience and Internet researching skills.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.