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
Aug 30, 2021
Physician
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. We’re looking to hire a Per Diem Utilization Management Medical Director to support our growing operations. This role will be a per diem position (20 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...