Clover Health · 1 month ago
Associate Chief Medical Officer, Medicare Advantage
United States
Full-time
Remote
Lead/Staff, Director/Executive
$321K/yr - $392K/yr
5+ years expClover Health is committed to providing high-quality, affordable healthcare plans for America’s seniors. They are seeking a visionary executive leader for the Associate Chief Medical Officer role to lead and elevate the Utilization Management function, ensuring clinical quality and compliance while driving down costs and delivering superior care for members.
Health CareHealth InsuranceHospitalMedical
Responsibilities
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
Qualification
Required
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
Competitive base salary and equity opportunities
Performance-based bonus program
401k matching
Regular compensation reviews
Comprehensive medical, dental, and vision coverage
No-Meeting Fridays
Monthly company holidays
Access to mental health resources
Generous flexible time-off policy
Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
Reimbursement for office setup expenses
Monthly cell phone & internet stipend
Paid parental leave for all new parents
Company
Clover Health
Clover is a healthcare technology company helping members live their healthiest lives with its Medicare Advantage plans.
501-1000 employees
Funding
Current Stage
Public CompanyTotal Funding
$1.62BKey Investors
GreenoaksSequoia CapitalFirst Round Capital
2021-11-17Post Ipo Equity· $300M
2021-01-08Post Ipo Equity· $400M
2021-01-08IPO
Leadership Team
Andrew Toy
Chief Executive Officer and Board Member (NASDAQ : CLOV)
Jamie Reynoso
Chief Executive Officer
Recent News
Fierce Healthcare
2026-01-19
2026-01-16
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