--- title: 'Physician Advisor – (P2P) Medical Reviewer (1099 Contractor) at Clover Health' canonical: 'https://feeny.ai/job/physician-advisor-p2p-medical-reviewer-1099-contractor-clover-health-united-0kfvwyg5817x' type: 'job' last_seen: '2026-09-25' --- # Physician Advisor – (P2P) Medical Reviewer (1099 Contractor) at Clover Health - **Company:** Clover Health - **Location:** United States - **Compensation:** $240k–$300k - **Work type:** remote - **Posted:** 2026-09-21 - **Last confirmed live:** 2026-09-25 - **Apply:** https://job-boards.greenhouse.io/cloverhealth/jobs/8220741 ## Job description Position Summary The Physician Advisor (1099 Contractor) is a licensed physician responsible for conducting clinical discussions with treating providers regarding utilization management determinations. The physician applies Medicare/CMS requirements, applicable medical necessity criteria, health plan policies, and clinical judgment to determine the appropriate level of care and/or medical necessity of requested services. The role supports timely, consistent, evidence-based utilization management while providing treating physicians an opportunity to discuss relevant clinical information before or following an adverse determination, as applicable. ## Key Responsibilities - Conduct scheduled and ad hoc peer-to-peer discussions with treating physicians and other qualified providers regarding inpatient, outpatient, post-acute, and other authorization requests. - Review the member's clinical documentation, utilization management review, applicable criteria, and rationale for the proposed or issued determination before the P2P discussion. - Evaluate medical necessity and the appropriate level of care, including inpatient versus observation/outpatient status when applicable. - Apply CMS Medicare Advantage requirements, the Two-Midnight benchmark, applicable NCDs/LCDs, MCG or other approved clinical criteria, and health plan policies as appropriate. - Discuss the clinical rationale for determinations clearly, professionally, and collegially with treating providers. - Consider additional clinical information presented during the P2P and determine whether it changes the medical necessity determination. - Approve or overturn a proposed adverse determination when newly presented information supports coverage, within delegated authority and organizational policy. - Escalate complex, high-risk, or unclear cases to the appropriate Medical Director or clinical leadership. - Document P2P discussions accurately and contemporaneously, including the clinical information discussed, physician participants, outcome, and rationale. - Complete P2P requests within established regulatory and organizational turnaround times. - Identify recurring clinical, documentation, criteria, or provider-education opportunities and communicate trends to UM leadership. - Collaborate with nurses, medical directors, appeals and grievances, provider engagement, and other operational teams as needed. - Maintain confidentiality and comply with HIPAA, CMS, accreditation, and organizational requirements. - Lead case review discussions on clinical JOCs ## Qualifications - MD or DO from an accredited medical school. - Current, unrestricted U.S. medical license. - Board certification in an appropriate clinical specialty; Internal Medicine, Family Medicine, Emergency Medicine, or another specialty with broad medical experience preferred. - Minimum of 5 years of clinical practice experience preferred. - Experience with utilization management, medical necessity review, physician advisory services, payer medical review, or hospital case management strongly preferred. - Experience with Medicare Advantage and CMS medical necessity/coverage requirements preferred. - Familiarity with MCG, InterQual, CMS coverage policies, and the Two-Midnight rule preferred. - Strong physician-to-physician communication skills and the ability to manage difficult or disputed clinical discussions professionally. Core Competencies - Excellent clinical judgment - Medical necessity and level-of-care expertise - Knowledge of Medicare/CMS requirements - Clear and concise physician communication - Timely decision-making - Accurate clinical documentation - Professional conflict resolution - Excellent communications skills - Consistent application of clinical criteria and policy - Ability to distinguish clinical medical-necessity decisions from contractual or administrative issues Performance Expectations Performance may be evaluated based on timely completion of P2Ps, regulatory turnaround-time compliance, documentation quality, decision accuracy and consistency, inter-rater reliability, provider experience, responsiveness, and adherence to CMS and organizational requirements. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc. A reasonable estimate of the base salary range for this role is: $240,000—$300,000 USD ## About Clover Health ## Company Overview - **One-liner**: Clover Health is a next-generation Medicare Advantage insurer that leverages a data-driven software platform, the Clover Assistant, to improve clinical decision-making and deliver affordable, preventive-focused healthcare plans to America’s seniors. - **Entity Type**: Public (ticker: CLOV – implied by investor relations presence at investors.cloverhealth.com) - **Headquarters**: Not explicitly stated in provided sources (roles listed in the U.S. include Houston, Texas; global team mentions Canada, Hong Kong, New Zealand) - **Founded**: Not disclosed in provided sources - **Founders**: Not disclosed in provided sources ## Core Business - **Primary industry**: Healthcare insurance (Medicare Advantage) with a strong technology component - **Target customers**: Seniors eligible for Medicare (B2C); also partners with physicians and providers (B2B) - **Mission or purpose**: “Improve every life” – combining technology and preventive care to lower costs and increase quality of life for members ## Products & Services - **[Clover Assistant]**: A flagship software platform that provides physicians with data-driven, personalized insights at the point of care. It is described as a “next-generation” tool that reduces doctor-insurer friction and improves clinical decision-making. Type: SaaS/platform. ## Market Standing - **Valuation/Market Cap**: Not disclosed in provided sources - **Key Metric**: As a public company, financials are reported in SEC filings (not included in search results). Job postings indicate active hiring across many departments (55+ open roles). - **Notable Investors/Partners**: Not explicitly listed in provided sources, but the company operates as a Medicare Advantage insurer with wide open networks. - **Growth Signals**: Global team spanning the U.S., Canada, Hong Kong, and New Zealand; remote-first hiring; roles in engineering, data science, actuarial, and clinical operations indicate scaling. ## Competitive Advantages - **Clover Assistant platform**: Provides physicians with real-time, personalized patient data, aligning incentives between insurer and provider to focus on preventive care. - **Patient-centered analytics**: A dedicated care management team identifies risks and delivers preventive care directly, reducing costs and improving outcomes. - **Remote-first model**: Allows access to a global talent pool and flexible work norms. ## Strategic Focus - Expanding Medicare Advantage plans with low premiums, $0 copays, and wide open networks - Deepening the use of the Clover Assistant to improve clinical outcomes and member satisfaction - Growing the provider network and member engagement through technology and care management ## Why Work Here - **Culture**: Mission-driven (“solve one of the country’s toughest problems”), values diversity and inclusion, with Affinity Groups and Employee Resource Groups. - **Remote/Hybrid**: Majority of roles are 100% remote; home office reimbursement provided. - **Perks**: “No Meeting Fridays,” monthly three-day weekends, flexible time off, generous holiday schedule, paid parental leave, learning programs, professional development funding, comprehensive medical/dental/vision, Employee Stock Purchase Plan. - **Engineering Culture**: Emphasis on data science, machine learning, AI, and site reliability engineering; roles for senior data scientists, ML engineers, and software engineers. ## Sources 1. [Clover Health Careers Page (Greenhouse)](https://job-boards.greenhouse.io/cloverhealth) 2. [Clover Health Careers (Main Site)](https://www.cloverhealth.com/about-us/careers) 3. [Clover Health Investor Relations – About](https://investors.cloverhealth.com/about) 4. [Clover Health About Us](https://www.cloverhealth.com/about-us/about-clover) 5. 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