Medical Director, Utilization Management (Part Time - Weekends)

Clover Health(6 days ago)

RemotePart TimeDirector$165,665 - $232,173 (estimated)Utilization Management

About this role

The Medical Director, Utilization Management at Clover Health provides clinical leadership within the utilization management program to support high-quality, cost-effective care aligned with the company’s Medicare Advantage plans. The role focuses on ensuring clinical consistency with company policies, regulatory requirements, and Clover’s data-driven care model. This is a part-time weekend coverage position within a remote-first organization.

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Required Skills

Utilization Management
Medical Review
Case Review
Medical Policy
Clinical Documentation
Medicare Advantage
Clinical Judgment
Data Analysis

Qualifications

MD
DO
Board Certification in Internal Medicine
Board Certification in Family Medicine
Board Certification in Emergency Medicine
Unrestricted US Medical License

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.