Job description
Company Overview:
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:
We are looking for a Medical Director who will lead our Cardiology Associate Medical Directors and perform clinical reviews. Reporting to the Senior Medical Director and part of the review team that includes non-clinical intake specialists and nurses, this is a critical role that is rapidly scaling to impact millions of patients. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives. This is a permanent remote, full-time position.
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:
- Lead a team of Cardiology Associate Medical Directors responsible for prior authorization clinical reviews and peer-to-peer discussions
- Inspire and motivate team members to perform at their best
- Demonstrated ability to oversee and collaborate with staff
- Proven experience managing a remote workforce and operating efficiently in a virtual environment
- Identify potential problems and points of friction and working to find solutions in order to maximize efficiency and revenue
- Develop and document standard operating procedures
- Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers
- Perform clinical reviews on a daily basis (50%)
- Provide timely medical reviews that meet Cohere’s stringent quality parameters
- Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen
- Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision
- Use correct templates for documenting decisions during case review
- Meet the appropriate turn-around times for clinical reviews
- Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
- Support the clinical guidelines team in developing and reviewing the company’s clinical decision guidelines in conjunction with client guidelines and directives
- Perform timely review of Medical Coverage Policies for our clients
- Maintain awareness of any changes in the literature, standard of care, or regulatory guidance impacting the criteria by which the company reviews service requests
- Maintain necessary credentials and immediately informs Cohere of any adverse actions relating to medical licenses and/or board certifications
- Perform other duties as delegated
Your Background and Requirements:
Required:
- Completed US-based residency program in Internal Medicine and fellowship program in Cardiology
- Board certification as an MD or DO with a current unrestricted state license to practice medicine - must maintain necessary credentials to retain the position
- 5+ years of clinical practice beyond residency/fellowship
Preferred:
- 2+ years of managed care utilization review experience
- 1+ years of direct supervision/management experience, preferably in a utilization management or payor organization
- Experience with clinical decision-making criteria sets (i.e., Milliman, InterQual)
- Membership in national and/or regional specialty societies
- Licensure in MN, VA, ND, IL, or TX is highly desirable - you should be willing to obtain additional state licenses with Cohere’s support
Competencies/Success Factors:
- Able to multitask and manage tasks to completion on a timely basis and in an organized fashion
- Excels in a matrix organization
- Strong interpersonal, oral and written communication skills
- Ability to work remotely and meet telephonically and/or via video with clinical colleagues and other personnel
- Proficient in using a Mac laptop computer and the Google Suite of applications
- Comfortable with technology - willing and able to learn new software tools
- Understanding of managed care regulatory structure and processes
- Detail-oriented, flexible, and able to work autonomously with little supervision
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 $275,000 to $295,000 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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