Medical Director, Utilization Management

Clover Health(5 months ago)

RemoteFull TimeSenior$280,000 - $310,000Healthcare Operations

About this role

Clover Health is seeking a Medical Director specializing in Utilization Management to oversee the evaluation of outpatient and inpatient medical appropriateness for healthcare members. The role involves supporting quality initiatives, reviewing medical necessity cases, and mentoring clinical staff, all within a mission-driven environment focused on improving health outcomes through data and technology.

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Required Skills

MedicalLicensing
UtilizationManagement
MedicareAdvantage
ClinicalEvaluation
MedicalPolicies
PeerReview
HealthcareQuality
CaseReview
Mentoring
DataAnalysis

Qualifications

MD or DO
Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or related
Unrestricted Medical License in US
Minimum 5 years clinical experience
At least 1 year Utilization Management review experience
Medicare Advantage experience

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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