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Clover Health
Lead RN, Utilization Management
Remote · USA · Full time · Senior level
$100k–$130k / year
About the role
Lead and develop clinical staff in utilization management. Oversee review operations and improve workflows to enhance member outcomes.
What you’ll do
• Lead and coach UM nurses and clinical reviewers. • Manage daily workloads and staffing coverage. • Ensure timely, accurate, and compliant reviews. • Partner with Medical Directors on complex cases. • Oversee vendor performance and implement improvements.
What you’ll bring
• Active, unrestricted RN license. • Bachelor of Science in Nursing or equivalent. • 5+ years clinical nursing, 3+ in managed care or UM. • Experience leading clinical staff and strong communication skills. • Knowledge of medical-necessity review and CMS requirements.
Life at Clover Health
Competitive salary with equity opportunities, comprehensive health coverage, mental health support, remote-first culture, and professional development programs.
About Clover Health
Clover Health provides affordable healthcare plans for seniors using data and technology to improve care quality and reduce costs.