# Senior Clinical/Operations Internal Monitoring Manager  at Clover Health

Clover Health is hiring a Senior Clinical/Operations Internal Monitoring Manager  for a remote role open to applicants in United States. It pays $129k-$168k a year and Level rates it Little AI ●○○○; you can [apply on Clover Health](https://jobsbylevel.com/go/9d63ad2e-5440-4dcb-8e33-ec70c6b6ee93?utm_medium=ai-agent).

AI Level 1, AI centrality 35 out of 100. Remote (Remote - USA).

## Details

- Company: [Clover Health](https://jobsbylevel.com/companies/clover-health)
- AI level: AI Level 1 (score 35 out of 100)
- Location: Remote (Remote - USA)
- Salary: $129k-$168k
- Posted: October 29, 2026
- Apply: https://jobsbylevel.com/go/9d63ad2e-5440-4dcb-8e33-ec70c6b6ee93?utm_medium=ai-agent
- Free CV review for this job: https://jobsbylevel.com/cv-review?job=senior-clinical-operations-internal-monitoring-manager-at-clover-health-69c400

## Description

The Senior Manager of Internal Monitoring plays a pivotal role in leading and overseeing second-level auditor monitoring across all ODAG functions—including Utilization Management (UM), Claims, and Appeals & Grievances—to ensure operational compliance and alignment with regulatory standards and Clover policies. Specifically, this role provides direct clinical monitoring leadership by conducting clinical evaluations for UM and clinical appeals to guarantee high-quality, sound clinical decision-making. In addition to guiding monitoring workflows and evaluating operating controls, the Senior Manager conducts risk-based operational audits, assesses alignment with clinical hierarchy, and drives process optimization through Artificial Intelligence (AI) integration. The Senior Manager also analyzes quality trends and root causes, delivers executive performance reporting, and collaborates cross-functionally with internal business leaders and BPaaS partners to resolve operational risks and execute effective remediation strategies. This role is also accountable for leading the Internal Monitoring function across clinical and non-clinical second-level monitoring, including helping to set the 6-12 month strategy, priorities, capacity, and operating approach. The Senior Manager leads and develops the Internal Monitoring team and ensures people, processes, and monitoring capabilities are aligned to evolving regulatory and business risks. As a Senior Cinical/Operations Internal Monitoring Manager, you will: Clinical Monitoring (UM & Clinical Appeals): Direct and perform second-level clinical reviews across Utilization Management (UM) and Clinical Appeals to evaluate auditor decision-making accuracy, compliance with clinical hierarchy, and adherence to medical policies and evidence-based guidelines. ODAG Second-Level Monitoring Management: Lead second-level monitoring programs encompassing all ODAG operational areas (UM, Claims, and Appeals & Grievances) to verify processing accuracy, maintain regulatory alignment, and evaluate key operating controls, including Sarbanes-Oxley (SOX) Claims QA Control testing. Lead and Develop the Internal Monitoring Team: Lead, coach, and develop team members responsible for clinical and non-clinical monitoring across ODAG functions. Set clear priorities and performance expectations, allocate work based on regulatory risk and capacity, hold team members accountable for quality and outcomes, and build the capabilities needed to deliver sustained monitoring effectiveness. Audit Analysis & Corrective Action: Analyze monitoring findings and data trends to identify root causes, uncover clinical improvement opportunities and process vulnerabilities, and oversee actionable remediation plans. Controls & Governance Assessment: Execute deep-dive clinical monitoring reviews to test the adequacy, effectiveness, and strength of internal controls, clinical decision-making protocols, standard operating procedures (SOPs), and regulatory guidance. Reporting & Stakeholder Engagement: Prepare and present comprehensive monthly quality performance and monitoring reports to key operational leaders, BPaaS and business partners, and compliance providing clear feedback, customer impact analysis, and actionable recommendations. Remediation & Risk Mitigation: Partner with processing teams, business leaders, Compliance, and BPaaS partners to design effective remediation strategies, follow monitoring errors through remediation, and validate results through focused post-remediation reviews. Quality Management & Focused Projects: Support quality projects and maintain monitoring tools to expand clinical quality monitoring, initiating focused quarterly audits based on emerging clinical risks. Training & Intervention: Identify critical clinical gaps requiring monitoring intervention. Work with business teams to support development of plans, tailored training materials, and refresher sessions to promote improved decision-making performance.

The description is cut here. Read the full offer: https://jobsbylevel.com/jobs/senior-clinical-operations-internal-monitoring-manager-at-clover-health-69c400

Source: https://jobsbylevel.com/jobs/senior-clinical-operations-internal-monitoring-manager-at-clover-health-69c400

## Cite this page

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