State Licensed Medical Director

Job Summary

To enhance the quality of care for members, the part-time State Licensed Medical Director will evaluate outpatient referrals and inpatient admissions for medical appropriateness, utilizing Medicare guidelines and Clover Health's medical policies while working remotely.

Key responsibilities

• Participate in and support Clover Health's Utilization Management processes
• Review authorization requests for medical necessity and evaluate authorizations for various healthcare services
• Mentor and coach Utilization Management nurses to improve effectiveness

Required qualifications

• MD or DO degree with Board Certification in a relevant specialty
• Valid, unrestricted medical license in a U.S. state
• Minimum of five years of clinical experience
• At least one year of experience as a Utilization Management reviewer
• Experience with Medicare Advantage plans