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Medical Director, Utilization Management at Clover Health - ApplyBlast

Medical Director, Utilization Management

Clover Health

2 days ago

3.7 on Glassdoor

Remote

Full Time

Director

0 applicants

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About this role

The Medical Director, Utilization Management is responsible for evaluating outpatient referrals and inpatient admissions to determine medical necessity and appropriate treatment plans for members. This role involves supporting quality improvement initiatives, mentoring clinical staff, and contributing to the development of clinical guidelines and policies. The position requires leveraging data and technology to deliver high-value, patient-centered care within a remote-first environment.

Responsibilities

Evaluate outpatient referrals and inpatient admissions for medical appropriateness
Review utilization management authorization requests for medical necessity
Mentor and coach utilization management nurses to strengthen effectiveness

Skills

Qualifications

MD or DO degreeBoard Certification in Internal Medicine, Family Medicine, Emergency Medicine, or a related specialtyvalid, unrestricted license to practice medicine in a U.S. state

About Clover Health

cloverhealth.com

Headquarters

Nashville, Tennessee, United States

Company Size

501-1000 employees

Founded

2014

View Profile

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.