Utilization Management Coordinator at Clover Health
Jersey City, NJ, US
Clover is reinventing health insurance by working to keep people healthier.

The Utilization Management & Appeals team is a group of dedicated, hard-working, enthusiastic individuals committed to ensuring Clover’s members receive medically necessary and quality care.

As a Coordinator, you will provide the highest level of service through every interaction. You will know the most about our members and be an advocate for their care. You will learn about our members' unique needs and work closely with our clinical staff, as well as many other teams, to ensure that our members are getting the right care at the right time. You’ll join a fast-growing startup, learn about the complexities of the healthcare system and be a part of our scaling company.

As a UM Coordinator, you will:

Prepare medical service authorization requests and appeals to give our nurses and M.D.s the information they need to give our members and providers the best possible clinical evaluation.
Collaborate with members, providers (nurses, doctors, hospitals, etc), and others to collect and research all relevant documents and background information to troubleshoot issues, and notify stakeholders of resolution.
Work cross-functionally with Clover's Claims and Enrollment teams for resolutions of payment, coding, and eligibility issues.
Partner with hospitals to track and log inpatient stays. You help to ensure Clover knows when members have been admitted and discharged - a critical part of our ability to coordinate care!
Address escalated issues from other departments within Clover that are related to the clinical care of members. Examples include: case edits (e.g., do the circumstances of a case merit a higher level of urgency?), helping to evaluate quantity edits (e.g., how many days does a member need to stay in the hospital to ensure proper treatment?), code corrections (e.g., do the service requested and the service billed for actually match?), and case management referrals (e.g., does this member need care above and beyond what was requested?).
Help shape the department by contributing to process documentation and training (e.g., meeting minutes, workflows and standing operating procedures).

You will love this job if:

You thrive in a collaborative environment, working together with other coordinators, nurses, doctors, engineers, data scientists, and product managers alike.
You are service oriented — you feel fulfilled in helping and supporting others to achieve common goals and resolve issues.
you have an insatiable curiosity and appetite to learn the mechanics of complex systems - healthcare is especially intricate and highly regulated.
You are a self-starter who learns new tools quickly and has a keen eye to improve things.
You believe fiercely in the protection of our members.
You understand that compliance is not just a set of rules you follow, it's the way you work.

You should get in touch if:

You have worked in healthcare.
You are driven by the mission of better healthcare for Americans.
You type at a speed of at least 65 WPM.
You have strong writing skills and have the aptitude to rephrase technical language into terms anyone can understand.

We are an E-Verify company.