Associate Chief Medical Officer, Medicare Advantage

3 days ago

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Clover Health

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Clover Health (Nasdaq: CLOV) is a physician enablement company focused on seniors who have historically lacked access to affordable, high-quality healthcareWe aim to provide great care, in a sustainable way, by having a business model built around improving medical outcomes while lowering avoidable costs. We do this while taking a holistic approach to understanding the health needs and social risk factors of those under our care. This strategy is underpinned by our proprietary software platform, the Clover Assistant, which is designed to aggregate patient data from across the health ecosystem to support clinical decision-making by presenting physicians and other providers with real-time, personalized recommendations at the point of care.Making care more accessible is at the heart of our business, and we believe patients should have the freedom to choose their doctors. We offer affordable Medicare Advantage plans with extensive benefits, provide primary care physicians with the Clover Assistant, and also make comprehensive home-based care available via the Clover Home Care program.With our corporate headquarters in Nashville, Clover’s workforce is distributed around the U.S. and also includes a team of world-class technologists based in Hong Kong. We manage care for Medicare Advantage members in Alabama, Arizona, Georgia, Mississippi, New Jersey, Pennsylvania, South Carolina, Tennessee, and Texas.We are hiring software engineers, data scientists, designers and product folks who can help us understand our members’ wellness and steer them clear of any health risks down the road.If you’re a passionate person and interested in changing healthcare for the better, then Clover Health may just be the place for you.

501 - 1000 employees

📋 Description

• Define and direct the strategic roadmap for all Utilization Management activities, ensuring clinical excellence, regulatory compliance, and alignment with Clover Health’s overall commitment to member health outcomes. • Provide executive oversight and mentorship to the Utilization Management team, including Medical Directors and UM nurses, fostering their clinical development and strengthening the effectiveness of the entire UM function. • Spearhead the ongoing development and implementation of Clover Health’s clinical guidelines, ensuring they incorporate current national standards (such as Milliman Care Guidelines, Interqual Criteria, and CMS Determinations) to consistently facilitate high-quality, medically appropriate care. • Act as a senior clinical liaison, engaging in high-level peer-to-peer discussions with network primary care physicians and specialists to resolve complex service requests and ensure seamless continuity of care for our members. • Lead operational excellence by evaluating utilization trends, developing educational resources for providers, and streamlining the UM, Grievance, and Appeals processes to reduce friction and improve transparency for physicians. • Drive quality improvement initiatives by partnering closely with Clover Health's Medical Management Committee to review the utilization process and ensure all decisions adhere to accepted standards for medical necessity.

🎯 Requirements

• You are a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) with an active, unrestricted medical license in a US State, and are board-certified in Internal Medicine, Family Medicine, or a related primary care specialty. • You have at least 5 years of demonstrated executive leadership experience (ACMO, CMO, or equivalent role) in a managed care, Medicare Advantage, or similar complex healthcare environment. • You possess extensive experience in Utilization Management/Review and have a proven track record of providing strategic leadership and clinical direction over a complex UM program in a Medicare Advantage or Managed Care setting. • You have demonstrated executive leadership ability in mentoring and coaching other physicians and clinical staff, with the ability to clearly communicate a clinical vision to diverse stakeholders and foster a collaborative team environment. • You are excited by complicated, industry-wide problems and possess a natural intellectual curiosity that drives you to find and implement creative, yet simple, technology-enabled solutions to improve patient care. • You have a deep understanding of, and experience applying, national standards for medical necessity such as Milliman Care Guidelines, Interqual Criteria, and CMS Coverage Determinations.

🏖️ Benefits

• Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions. • Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare. • Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location. • Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews. • Additional Perks: Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities • Reimbursement for office setup expenses • Monthly cell phone & internet stipend • Remote-first culture, enabling collaboration with global teams • Paid parental leave for all new parents • And much more!