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 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:
You will love this job if:
You should get in touch if:
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.