Cohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patient’s healthcare experience, both in and out of the doctors office. Founded in August, 2019, we are obsessed with eliminating wasteful friction patients and doctors experience in areas that have nothing to do with health and treatment, particularly for diagnoses that require expensive procedures or medications. To that end, we build software that is expressly designed to ensure the appropriate plan of care is understood and expeditiously approved, so that patients and doctors can focus on health, rather than payment or administrative hassles.
In this role you will join Cohere Health at a key inflection point to help build and run our clinical programs necessary to deliver a radically improved pre-authorization experience for physicians, their staff, and most importantly, patients. This means that you will help design the protocols and operations that effectively align prior authorization policies with evidence-based, safe and timely care, and be a part of the initial team conducting clinical review of authorization requests. The candidate must be experienced enough to be a seasoned subject matter expert and be willing to participate in the entire review process, delivering high quality review in service of patients and the care plans outlined by their physicians. This is not a typical utilization management environment. We are looking for nurses who are passionate about how this work fits into delivering best-in-class outcomes and enabling true collaborative care.
What will you do
- Leads the day to day operations of the leadership team responsible for the Nurse clinical operations team
- Guides team members in the adherence to applicable standards of care/practice and/or departmental/organizational expectations
- Create a collaborative, cohesive work environment where team members thrive
- Ensures implementation of a performance improvement program to drive quality care, positive patient outcomes, and address negative trends.
- Strong financial acumen responsible for establishing budgets and forecasts and delivering results that improve overall profitability for the department
- Drive efficient flow of work throughput, with emphasis on cost improvement, cycle time (service) and production time reduction
- Monitor performance and productivity of the team and individual members; lead appropriate operational change and take action to ensure guidelines and goals of the department are met
- Ensures issues and deficiencies identified during internal or external surveys or audits are addressed and corrected
- Maintains collaborative/cooperative relationships with others in the organization by sharing meaningful information, soliciting feedback and exhibiting respect and support
- Partner with the Quality and Training team to ensure a robust quality program
- Partner with intake team to ensure seamless handoffs, timely response, and a unified experience for physician practices and their patients
- Complete performance reviews and mentor the Nurse leadership team and team members
- Actively model a commitment to quality and safety, championing Cohere Health standards and training.
- Participate in the implementation of innovation and new approaches so as to experiment with workflow designs that best enable expeditious, evidence-based care.
- Align personal work effort with the achievement of Key Performance Indicators (KPIs) that align with Cohere Health’s mission and focus to facilitate safe, team-based, and patient centered care with an experience that is next to none
Your background & responsibilities
- Bachelor's degree or higher; And/or equivalent in years of experience
- Must be able to demonstrate effective organizational, management, leadership and problem-solving skills, Proven successful experience leading, coaching, and mentoring management is required
- Experience in utilization review
- Operations leadership experience with a demonstrated track record of operational success and business maturity
- Experience in Commercial, Medicare and Medicaid insurance payors
- Knowledge of scheduling and allocation of resources to best achieve effective patient care, and employee resources
- Strong computer skills, including demonstrated skill in the use of MacBook and web-based tools. If not familiar with certain hardware or software, have a track record for learning new systems quickly.
- An exceptional communicator, both verbal and written.
- Customer service orientation.
- Experience managing remote teams
- Demonstrated ability to adapt, innovate and lead in an environment that moves at a rapid pace, where change is common
We can’t wait to learn more about you and meet you at Cohere Health!
Equal Opportunity Statement
Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it’s personal.