Medical Director, Payment Integrity & Utilization Management

Clover Health(17 days ago)

RemoteFull TimeSenior$270,000 - $330,000Medical Management

About this role

Clover is a healthcare company focused on improving outcomes for members through data integration and clinical insights. They are seeking a detail-oriented Medical Director with experience in Payment Integrity and Utilization Management to oversee clinical review processes and contribute to quality improvement initiatives.

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Required Skills

Medical Records Review
Payment Integrity
Utilization Management
Clinical Judgment
Medicare Advantage
Peer Review
Clinical Decision-Making
Healthcare Data Analysis
Medical Necessity
Case Reviews

About Clover Health

cloverhealth.com

Clover Health is a Medicare Advantage provider offering HMO and PPO plans—many with $0 monthly premiums—bundling expanded benefits like dental, vision, and hearing. Headquartered in Jersey City, NJ, the company serves Medicare beneficiaries across multiple U.S. markets. Clover emphasizes a technology- and data-driven approach to care management, aiming to support providers, coordinate primary care, and improve member outcomes. It positions itself as a member-focused alternative designed to lower costs and simplify access to preventive and routine services.

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