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.

Jan 07, 2022
Physician
Clover Health Remote
Clover is reinventing health insurance by working to keep people healthier. Clover Health 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. As an Appeals Medical Director, you will: Be responsible for appeal reviews and determination for medical appropriateness. Utilize Local and National Medicare Coverage Determinations, MCG criteria,  and Clover Health’s medical policies reviews  to determine medical necessity required for our members. Send appropriate cases to the IRE. You will love this job if: You are dedicated to improving the quality of life of members by providing superior, personalized, patient-centered care. You are excited by...