Clover is reinventing health insurance by working to keep people healthier.

Clover is a Medicare Advantage plan working to develop deeper insights to drive better outcomes for our members through our integrated technology platform. We rely on our abilities to integrate standard health plan data (eligibility, provider network, claims, authorizations, etc.) with clinical information from provider health information systems.

This is a full time position that participates in and is responsible for certain quality measurement, control and improvement activities that take place in the Medical Management area (i.e. UM and Appeals). The position reports to the Chief Medical Officer, Medicare Advantage (CMO).

As a Medical Director, you will:

• Review ongoing sample cases of medical decision-making by vendors and delegated providers.
• Support QA team in evaluating and improving UM and Appeal processes.
• Coach and train clinical decision makers to improve proper selection and application of medical  necessity  guidelines.
• Perform in-depth trend data analysis and develop quarterly performance reports.
• Support the Senior Medical Director by ...