At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors.
We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations.
By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most.
The Utilization Management (UM) team plays a vital role in supporting Clover members throughout their care journey.
The team is made up of experienced clinicians who combine clinical expertise with data-driven insights to support evidence-based decision-making.
Working closely with providers and care partners, the UM team ensures that care transitions are smooth, efficient, and always focused on improving member outcomes while maintaining compliance with CMS guidelines.
As the Lead RN, Utilization Management, you will coach and develop clinical staff, oversee daily review operations, and monitor quality and vendor performance.
You will partner with Medical Directors and teams across Clover to strengthen review consistency and improve workflows.
The ideal candidate brings sound clinical judgment, strong leadership.
As a Lead RN, Utilization Management, you will: Lead, coach, and onboard Utilization Management nurses and clinical reviewers; use case audits and feedback to support staff development and accountability.
Partner with Medical Directors on complex cases, peer-to-peer reviews, and cases requiring physician review.
Oversee vendor contracting, implementatio.