Remote opportunity at
Clover HealthLead Medical Director, Utilization Management
Clover Health operates as a healthcare company focused on delivering affordable, straightforward insurance plans for seniors while emphasizing preventive medicine. Through its proprietary Clover Assistant technology,…
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About This Role
Clover Health operates as a healthcare company focused on delivering affordable, straightforward insurance plans for seniors while emphasizing preventive medicine. Through its proprietary Clover Assistant technology, the organization equips physicians with comprehensive patient histories to facilitate informed medical recommendations and enhance care delivery. The Utilization Management group oversees access to suitable medical services by applying timely, evidence-based standards. The organization seeks a Lead Medical Director for Utilization Management to handle…
Job Description
Clover Health operates as a healthcare company focused on delivering affordable, straightforward insurance plans for seniors while emphasizing preventive medicine. Through its proprietary Clover Assistant technology, the organization equips physicians with comprehensive patient histories to facilitate informed medical recommendations and enhance care delivery. The Utilization Management group oversees access to suitable medical services by applying timely, evidence-based standards.
The organization seeks a Lead Medical Director for Utilization Management to handle the evaluation of outpatient referrals and direct inpatient admissions to verify medical necessity. This remote full-time position requires supervising a team of medical directors, reviewing complex cases, and chairing the Utilization Management Committee. Selected candidates will establish and update clinical policies, guide regulatory adherence, and collaborate closely with operational, quality, and compliance departments. The role compensates an annual base salary between USD 320,000 and 340,000, complemented by comprehensive financial, physical, and mental well-being benefits.
Responsibilities
- Handle prior authorization, concurrent, retrospective, and other utilization management cases using sound clinical judgment within established deadlines
- Direct and oversee a team of Utilization Management Medical Directors
- Evaluate complex or escalated medical cases and secure specialty consultations when necessary
- Lead the Utilization Management Committee by directing agendas, sharing policy updates, and recording determinations
- Contribute to the Credentialing Committee and the Quality Committee by offering clinical insights and tracking performance metrics
- Conduct peer-to-peer discussions, handle appeals, and engage in provider education
- Collaborate across departments including care management, compliance, pharmacy, network, and operations
Requirements
- Possess an MD or DO degree
- Hold an active and unrestricted medical license
- Maintain board certification in a relevant clinical specialty
- Bring a minimum of five years of clinical practice experience focused on utilization management or medical necessity reviews
- Demonstrate at least five years of leadership background managing a clinical team directly
Core Skills
Benefits
- Competitive base salary with equity opportunities and a performance-based bonus program
- 401k matching and periodic compensation reviews
- Comprehensive medical, dental, and vision insurance coverage
- Flexible time-off policy, monthly company holidays, and No-Meeting Fridays
- Employee Stock Purchase Plan providing discounted equity options
- Stipends covering office setup expenses, monthly cell phone, and internet costs
- Paid parental leave for new parents
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
What is the salary for the Lead Medical Director role?
The annual base salary range for this position is between USD 320,000 and 340,000, determined by factors such as internal equity, market data, education, and experience.
Is this position remote?
Yes, the posting explicitly states that the role is remote and operates within a remote-first culture.
What experience is required for this position?
Candidates must have at least five years of clinical practice experience in utilization management or medical necessity review, along with a minimum of five years of leadership experience directly managing a clinical team.
What educational and licensing credentials are needed?
Applicants are required to have an MD or DO degree, an active and unrestricted medical license, and board certification in a relevant clinical specialty.
Sample Interview Questions
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