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Physician Advisor at Clover Health - ApplyBlast

Physician Advisor

Clover Health

1 month ago

3.7 on Glassdoor

Remote

Contract

Senior

2 applicants

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About this role

The Physician Advisor conducts clinical discussions with treating providers to determine the medical necessity and appropriate level of care for requested services. This role applies Medicare/CMS requirements, clinical criteria, and health plan policies to support timely and evidence-based utilization management. The position involves reviewing clinical documentation, engaging in peer-to-peer discussions, and making coverage determinations within delegated authority.

Responsibilities

Conduct peer-to-peer discussions with treating physicians regarding utilization management determinations
Evaluate medical necessity and appropriate level of care using CMS and clinical criteria
Review clinical documentation and determine coverage based on health plan policies and regulations

Skills

Qualifications

MDDOU.S. medical licenseBoard certification in an appropriate clinical specialty

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.