Medical Director, Payment Integrity & Utilization Management

Clover is seeking a Medical Director, Payment Integrity & Utilization Management to lead clinical case reviews and ensure medical necessity, appropriate utilization, and payment accuracy.

Requirements

• MD or DO with a valid, unrestricted license to practice medicine in a US State
• Board Certified, preferably in Internal Medicine, Family Medicine, or Emergency Medicine
• At least 5 years of clinical experience, including inpatient experience
• Strong experience in Payment Integrity and Utilization Management/Review and a solid understanding of Medicare Advantage
• Experience or expertise with peer review committees
• Extremely detail-oriented and meticulous, with a genuine enjoyment of digging into medical records to find the "needle in the haystack"
• Discerning clinical judgment and an investigative, problem-solving mindset
• Thrive in collaborative, cross-functional settings and have strong proficiency with technology

Benefits

• Competitive base salary and equity opportunities
• 401k matching
• Regular compensation reviews to recognize and reward exceptional contributions
• Comprehensive medical, dental, and vision coverage
• No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy
• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Paid parental leave for all new parents
• Professional development funding and regular performance feedback and reviews
• Remote-first culture, enabling collaboration with global teams