Medical Director, Utilization Management

Clover Health is seeking a Medical Director, Utilization Management to evaluate outpatient referrals and inpatient direct admissions for medical appropriateness. The physician will utilize Local and National Medicare Coverage Determinations, Milliman Care Criteria, and Clover Health’s medical policies reviews to determine medical necessity or if an alternate treatment plan is required for our members.

Requirements

• MD or DO degree
• Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or a related specialty
• Valid, unrestricted license to practice medicine in a U.S. state
• Minimum of five years of clinical experience
• At least one year of experience as a Utilization Management reviewer
• Medicare Advantage experience

Benefits

• Performance-based bonus program
• 401k matching
• Comprehensive medical, dental, and vision coverage
• No-Meeting Fridays
• Monthly company holidays
• Mental health resources
• Flexible time-off policy
• Employee Stock Purchase Plan (ESPP)
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Paid parental leave