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

Utilization Management is responsible for ensuring Clover members have access to the right care at the right time in the right setting. Our clinical and operational staff work together to ensure timely and clinically appropriate decisions are made for all prior authorizations for Clover members in accordance with CMS compliance.

As the Utilization Management Operations Coordinator, you will be responsible for partnering with and monitoring Clover's vendors and in-house processes.

As an Operations Coordinator, you will:

• Assist with managing vendor relationships for non-clinical Utilization Management (UM), workflows.
• Monitor priority cases and report on key performance indicators.
• Maintain and organize internal UM policies and procedures.
• Support UM projects and process improvement initiatives.
• Perform quality assurance (QA) reviews of non-clinical UM processes to ensure accuracy, efficiency, and compliance with regulations.
• Assist with data entry and analysis to support UM reporting and decision-making.
• Identify and escalate procedural gaps and compliance concerns.
• Develop and implement operational ...