Design and validate data mapping and integration solutions to power payment integrity products. Serve as a subject matter expert by mentoring analysts and partnering with stakeholders to ensure data accuracy and scalability.
Cohere Health
35 Remote Job Openings at Cohere Health
Lead the technical design and end-to-end delivery of features and platform enhancements for a cloud-based healthcare platform. Mentor junior engineers and collaborate with product and design teams to ensure high-quality user experiences.
Lead the engineering teams responsible for AI platform infrastructure, agent runtime systems, and MLOps/LLMOps to operationalize AI capabilities. Oversee the deployment of AI-powered solutions and the management of prompt and skills lifecycles within healthcare customer environments.
Lead and grow a distributed engineering team to build scalable AI platforms, agents, and data architectures for health insurance plans. Partner with cross-functional teams to translate business needs into technical solutions while ensuring HIPAA compliance and operational excellence.
Conduct exploratory data analysis and predictive modeling on healthcare claims data to identify trends and insights. Collaborate with cross-functional teams to deliver analytical reports and data visualizations that support business decision-making.
Design, build, and maintain scalable data pipelines for ingesting and transforming data from various sources. Collaborate with cross-functional teams to deliver production-ready data products and ensure platform reliability through monitoring and on-call support.
Conduct comprehensive professional and facility coding reviews to ensure accuracy in code assignment and reimbursement. Identify overpayments and craft well-supported audit findings based on AHA Coding Clinic Guidelines and regulatory standards.
Conduct comprehensive professional and facility coding reviews to ensure accuracy in code assignment and maximize overpayment identification. Utilize advanced DRG encoder tools and industry guidelines to craft well-supported audit findings and maintain compliance.
Oversee and develop a team of RN Reviewers to ensure performance metrics and quality standards are met. Manage daily operational activities, including productivity reports, timeliness tracking, and process efficiency improvements.
The analyst optimizes workforce performance by managing intraday operations, forecasting staffing needs, and monitoring queue performance for clinical and intake teams. They provide actionable insights through performance reporting and identify opportunities for process improvement and automation.
Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accurate reimbursement and identify overpayments. Create well-supported audit findings based on AHA Coding Clinic Guidelines and ICD-10 regulations while maintaining high quality and productivity standards.
Perform medical reviews to determine the appropriateness of musculoskeletal and orthopedic services using evidence-based guidelines. Document clinical decisions accurately within workflow tools and collaborate with a multidisciplinary review team.
The Medical Director will determine the medical appropriateness of services by reviewing clinical information against evidence-based guidelines. They will also conduct peer-to-peer discussions with providers and support the clinical content team in refining decision guidelines.
Conduct medical necessity reviews and prepare compliant clinical determinations for members and providers. Collaborate with Medical Directors to ensure evidence-based decisions align with regulatory and accreditation standards.
Drive the identification and recovery of improper claim payments by developing auditing algorithms and technical specifications. Act as a player-coach collaborating with Data Science and IT teams to ensure financial accuracy for payer clients.
Senior Software Engineer, Client Implementations
Cohere Health
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Full Time
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a month ago
Cohere Health
Build and operate mission-critical healthcare technology across the full stack, including backend services and provider-facing web applications. Lead epic-level efforts from technical design through production deployment while mentoring other engineers.
Lead the strategic process to help health plan prospects develop business cases for utilization management transformation. Partner with executives to advise on market trends and serve as a subject matter expert during sales demonstrations to drive growth.
Oversee the day-to-day execution and operational outcomes of specific clinical specialty programs to align with strategic objectives. Coordinate across Clinical Strategy, Operations, Analytics, and Client Success teams to drive program performance and continuous improvement.
Perform medical reviews and clinical determinations for musculoskeletal and orthopedic programs using evidence-based guidelines. Conduct peer-to-peer discussions with providers to explain review outcomes and document decisions within workflow tools.
Conduct medical necessity reviews and prepare compliant clinical determinations and correspondence for members and providers. Collaborate with Medical Directors to ensure evidence-based decisions align with regulatory and accreditation standards.
Translate quality control feedback and clinical audit concepts into high-impact training modules for the medical audit team. Conduct virtual workshops and track post-education accuracy scores to reduce variance and improve reimbursement solutions.
Strategic Medical Director, PM&R / Post-Acute Care & DME
Cohere Health
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Full Time
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a month ago
Cohere Health
Lead the vision and design of clinical and digital care management programs as a subject matter expert in PM&R and post-acute care. Collaborate with growth and product teams to evangelize the company's vision to clients and optimize clinical delivery services.
Serve as the primary financial partner for operating groups to improve profitability, scalability, and contribution margins. Lead budgeting, forecasting, and operational reporting while managing India-based financial analysts.
Manage and mentor a team to translate client technical requirements into scalable platform configurations for PaaS clients. Partner with Product, Engineering, and Design to improve internal configuration tools and resolve technical issues during implementation.
Conduct quantitative analyses on healthcare costs and clinical outcomes to optimize auto-decisioning strategies and product performance. Develop reporting solutions and data visualizations to provide actionable insights for internal stakeholders and clients.
Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in reimbursement and identify overpayments. Create well-supported audit findings based on AHA Coding Clinic Guidelines and ICD-10 regulations.
Lead commercial contracting efforts by drafting and negotiating a wide range of agreements, including SaaS and enterprise customer contracts. Provide legal guidance to internal stakeholders to support product offerings and mitigate risks while scaling the business internationally.
Lead and manage the DRG, Professional, and Outpatient audit teams to ensure operational objectives and quality metrics are met. Oversee onboarding, training, and quality reviews while maintaining superior knowledge of coding guidelines and reimbursement trends.
Lead the design and evolution of clinical and digital care management offerings as a subject matter expert. Collaborate with growth and product teams to align clinical strategy with client needs and drive go-to-market efforts.
The Medical Director will lead the vision and evolution of clinical and digital care management offerings while serving as a subject matter expert. They will collaborate cross-functionally to drive clinical strategy, support growth initiatives, and manage client relationships to ensure effective program delivery.
Staff Software Engineer - Platform Engineering
Cohere Health
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Full Time
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2 months ago
Cohere Health
Lead the development of scalable, reliable platform infrastructure while driving deployment and release strategies to improve speed and safety. Partner cross-functionally to establish observability and SRE practices while mentoring teams on platform and reliability best practices.
Associate Medical Director, Orthopedic Surgery
Cohere Health
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Full Time
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5 months ago
Cohere Health
Physicians will deliver on musculoskeletal and orthopedic programs by determining the medical appropriateness of services through clinical review and application of evidence-based guidelines. Key duties include providing timely medical reviews, accurately documenting decisions, and conducting peer-to-peer discussions with treating providers.
Design, build, and deploy advanced machine learning systems for various use cases while collaborating with cross-functional teams. Lead model development across the ML lifecycle and drive experimentation tied to business outcomes.
The Associate Medical Director will review clinical information and apply evidence-based guidelines to determine the medical appropriateness of services within Cohere’s Cardiology program. This role involves providing expert input on clinical decision guidelines and conducting peer-to-peer discussions with treating providers.
The Senior Business Analyst will support the execution and continuous improvement of clinical programs by providing data, documentation, and process discipline. This role involves transforming program strategy into deliverables such as dashboards and performance reports to ensure program success.
