This company operates with a remote-first culture, allowing team members to work from anywhere. Team members are distributed across the U.S. and Canada.
Review Home Health prior authorization requests for medical necessity using CMS regulations, NCD/LCD, and company clinical guidelines.
Perform initial and concurrent clinical reviews for Home Health services to ensure medically necessary care in the least restrictive setting.
Ensure timely completion of utilization management reviews in accordance with CMS requirements and company policies.
Collaborate with home health agencies, physicians, and internal teams to obtain clinical documentation for accurate determinations.
Identify opportunities to optimize care plans while promoting appropriate utilization of services.
Apply clinical judgment and critical thinking to support evidence-based decisions and escalations to Medical Directors.
Maintain accurate and timely documentation within utilization management platforms and electronic medical records.
Build collaborative relationships with provider partners to facilitate timely authorizations.
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About Clover Health
Clover Health is reinventing health insurance for older Americans by combining technology with empathy. You'll find them focused on Medicare Advantage plans, specifically using their proprietary software, Clover Assistant, to empower physicians. This platform synthesizes patient data, enabling doctors to make more informed decisions and proactively deliver preventive care. The goal is to reduce avoidable spending and manage chronic diseases effectively, ultimately helping members live healthier lives at a lower cost.
How We Work
Clover Health champions a remote-first culture, fostering collaboration across globally distributed teams, including those in the United States and Hong Kong. They prioritize your mental well-being with initiatives like No-Meeting Fridays, monthly company holidays, and a flexible time-off policy. The company values diversity and inclusion, believing that varied perspectives are crucial to solving complex healthcare problems and serving their diverse member base.
Engineering at Clover Health
Clover Health is a technology company at its core, building custom software and analytics to transform healthcare. Engineers tackle complex challenges in a data-rich, regulated environment, often utilizing AI and LLM tools to create agentic systems and AI-assisted workflows. The Clover Assistant, their flagship platform, aggregates data from across the healthcare ecosystem, delivering real-time, personalized insights to physicians. This allows for earlier identification and management of chronic diseases. You'll contribute to systems that directly influence patient outcomes and operational efficiency, navigating the unique complexities of the Medicare landscape.
Why Join Us
Drive real-world impact by building technology that directly improves the health and well-being of older Americans.
Work in a remote-first environment that prioritizes your work-life balance and offers flexible time off and no-meeting Fridays.
Contribute to a mission-driven team solving one of the most complicated problems in the world: healthcare.
Access professional development opportunities including learning programs, mentorship, and funding to support your continuous growth.
Benefits & Perks
Competitive base salary, equity opportunities, and performance-based bonus program.
Comprehensive medical, dental, and vision coverage.
401k matching and Employee Stock Purchase Plan (ESPP).
Reimbursement for home office setup expenses.
Monthly cell phone and internet stipend.
Paid parental leave for all new parents.
Monthly company holidays and a generous flexible time-off policy.
Allowance for over-the-counter health items and a rewards program for healthy activities.