Cohere Health is a fast-growing clinical intelligence company that’s improving lives at scale by promoting the best patient-specific care options, using cutting-edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health plans covering over 15 million lives, while our revenues and company size have quadrupled. That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include: 2023 and 2024 BuiltIn Best Place to Work; Top 5 LinkedIn™ Startup; TripleTree iAward; multiple KLAS Research Points of Light awards, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.

Opportunity Overview:

Clinical Training & Quality Specialist will work in support of the Service Operations Team at Cohere Health who conduct reviews and decision Prior Authorization requests for a patient’s medical insurance . You will implement clinical training and quality processes, scoring, and performance improvement data designed to improve operational efficiency while exceeding industry standards for quality performance and clinical guidance. You will provide support to all functions within the Training & Quality department. With a solid foundation in Training and Quality, you are expected to be flexible and nimble in your role to manage short- and long-term projects as well as dealing with day-to-day tasks. Cohere culture is one of partnership and ownership.

Last but not least: People who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

What you will do:

Audit Individual Operations team members on Clinical decisions against clinical guidelines
Facilitate training for the RN Clinical team on Cohere Clinical decisioning process and job functions
Meet required audit counts
Coach team members for improvement against quality metrics
Provide reporting on performance and key areas of quality improvement to Sr Leadership

Your background & requirements:

Active RN Licensure
Experience in the process of Coverage Determinations in Healthcare
- NCQA and CMS standards for Utilization Management Authorization decisions
- LCD/NCD Coverage Determination
Ability to conduct effective coaching sessions
Understanding of Adult Learning Theory and Training RN
Attention to detail

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.

The salary range for this position is $70,000 to $80,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

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Are you currently a licensed Registered Nurse with an active nursing license? *

Do you have at least 1 year of utilization management experience? *

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Clinical Training and Quality Specialist

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