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Clover Health
Senior Clinical/Operations Internal Monitoring Manager
Remote · United States · Full time · Senior level
$129k–$168k / year
About the role
Lead second-level auditor monitoring across ODAG functions to ensure compliance and quality clinical decision-making. Manage internal monitoring team and optimize processes using AI integration.
What you’ll do
• Direct second-level clinical reviews for UM and Clinical Appeals. • Lead second-level monitoring across UM, Claims, Appeals & Grievances. • Coach and develop internal monitoring team. • Analyze audit findings and oversee remediation plans. • Prepare quality performance reports for stakeholders.
What you’ll bring
• Active, unencumbered Registered Nurse (RN) license. • 3+ years in internal monitoring or clinical quality oversight. • Experience with CMS Program Audits and Medicare Advantage guidelines. • Proven leadership and team development skills. • Strong analytical and communication skills.
Life at Clover Health
Competitive salary with equity opportunities, 401k matching, comprehensive health coverage, mental health resources, remote-first culture, and professional development programs.
About Clover Health
Clover Health combines data and human empathy to improve healthcare outcomes through custom software and analytics, focusing on personalized care and member health.