Get roles like this, scored and matched, in your inbox.
Sign up free →Job Opening
Lead RN, Utilization Management
Clover Health · Remote - USA · Posted 16 days ago
"Lead and develop a team of clinical reviewers while using data to sharpen Medicare Advantage utilization management workflows for Clover's members."
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 skills, and a commitment to putting members first.
As a Lead RN, Utilization Management, you will:
…
This posting is sourced from Clover Health's own career site — applying takes you there directly.
Get roles like this, scored and matched, in your inbox.
Sign up free →Related roles
This role centers on Utilization Management, Medicare Advantage, Interqual, and Mcg. There are 57 open roles at Clover Health right now.
Want roles like this found for you?
Set your Focus once. Career Engine screens every new opening every week.
A scored, explained shortlist — not a keyword match — delivered weekly. Free for one profile.