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.
Cohere Health
31 Remote Job Openings at Cohere Health
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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5 days 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.
Manage and grow key client relationships within the Payment Integrity Team while serving as a liaison between internal cross-functional teams. Analyze client data and trends to drive strategic decision-making and improve the overall customer experience.
Manage strategic operations and staff responsible for provider outreach to support audit operations. Lead cross-functional initiatives, design new processes, and develop high-quality presentation materials for leadership.
Act as the primary point of contact for healthcare providers to expedite medical records requests and resolve inquiries. Collaborate cross-functionally with audit operations teams to ensure compliance and support the payment integrity process.
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.
Drive accounting functions including general ledger management, month-end close, and technical accounting analysis under ASC 606. Oversee finance operations such as billing, accounts payable, accounts receivable, and cash management.
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.
Configure and maintain medical coverage policies within the product platform to ensure accuracy and compliance with industry standards. Collaborate cross-functionally with clinical experts and engineering teams to optimize policy implementation and usability.
Lead the design and delivery of scalable data platform services and APIs to support critical business and clinical workflows. Provide technical leadership through mentoring, code reviews, and collaboration with cross-functional teams to ensure operational excellence.
Drive the end-to-end implementation process for new healthcare clients, acting as the primary liaison between client teams and internal cross-functional teams. Develop implementation playbooks and best practices to create a repeatable model for future customer onboarding.
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.
Conduct quality audits of inpatient clinical determinations to ensure alignment with guidelines and standards. Provide coaching, develop training materials, and partner cross-functionally to improve clinical decision accuracy and operational efficiency.
The RN Reviewer performs prospective, concurrent, and retrospective medical necessity reviews to ensure cost-effective and high-quality care. They collaborate with Medical Directors and providers to align on clinical decisions while maintaining compliance with established guidelines.
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.
The Sr. Compliance Reporting Analyst is responsible for conducting compliance audits, managing quality assurance for regulatory submissions, and ensuring adherence to federal and state healthcare regulations. They will analyze data, document findings, and collaborate with stakeholders to implement process improvements and corrective actions.
Staff Software Engineer - Platform Engineering
Cohere Health
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Full Time
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a month 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.
The Senior Forward-Deployed Engineer will own end-to-end technical integration design and execution for enterprise customers, bridging complex healthcare systems with Cohere’s AI platform. They will lead technical discovery, scoping, and architectural design while collaborating cross-functionally to ensure successful production deployments.
The Lead Data Governance Specialist will drive best practices in data management and establish an enterprise data catalog to ensure data trustworthiness. They will collaborate cross-functionally to maintain data quality standards, security controls, and data literacy across the organization's platforms.
Design and build high-quality, scalable software applications to support clinical decision-making and payment integrity. Collaborate with cross-functional teams to ensure feature functionality meets business and client requirements.
The role involves designing, developing, testing, and deploying end-to-end features and platform enhancements across cloud infrastructure and web applications, owning the full software development lifecycle from design through monitoring. Responsibilities also include collaborating with cross-functional teams to deliver high-quality user experiences and leading technical design discussions.
Associate Medical Director, Orthopedic Surgery
Cohere Health
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Full Time
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4 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.
