Lead RN, Utilization Management

Clover Health · Remote, USA

Full-timeRemoteToday

Not open to applicants in Nigeria. This employer hires from: United States only. Apply only if you are based there.

Wrong label? ·

Your match score

Scored out of 100 against your CV

We only show a number once we have read your CV. Before that, any number would be a guess.

Score, strengths and gaps· upload your CV to unlock

Apply for this role ↗

About this role

The Lead RN, Utilization Management role at Clover Health, based remotely in the USA, involves coaching and developing clinical reviewers, overseeing daily review workloads and escalations across prospective, concurrent, and retrospective reviews, and ensuring determinations are timely and compliant with CMS guidelines. The position suits an experienced RN with sound clinical judgment and leadership ability who can work closely with Medical Directors and care teams to improve review consistency. A standout requirement is the responsibility for vendor performance oversight alongside staff quality and development.

Sourced via Jobicy · HirePadi job board

← Browse all jobs