Clinical Integrity Manager

🕒 Yesterday

🇺🇸 United States – Remote

💵 $96k - $125k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Cohere Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cohere Health is a company focused on transforming the prior authorization process in healthcare using advanced technologies. The company offers the Cohere Unify™ Platform, which includes artificial intelligence and machine learning capabilities to improve utilization management (UM) and facilitate quicker access to patient care. By digitizing the prior authorization process and integrating with electronic medical records, Cohere Health aims to enhance the quality of healthcare outcomes and reduce the administrative burden on providers. Their solutions help decrease denial rates and adverse outcomes through evidence-based intelligence and real-time clinical suggestions. Cohere Health's offerings are available as Platform as a Service (PaaS) or as fully outsourced solutions.

📋 Description

• Perform clinical reviews of products, workflows, and programs for evidence-based practice, regulatory requirements, and client expectations • Write and refine clinical requirements, user stories, and acceptance criteria for UM workflows, clinical decision support, and AI-enabled capabilities • Represent clinical integrity in sprint planning and design sessions with Product and Engineering • Run hands-on UAT, build test scripts and scenarios, document defects, and track readiness for releases and client implementations • Audit client commitments and SLAs against product capabilities, flag gaps, and drive remediation • Build and maintain governance documentation, SOPs, playbooks, and training materials • Partner with Clinical Operations, Product, Engineering, Client Success, Compliance, Legal, and Clinical Strategy • Contribute clinical assessments, RFP/RFI responses, and feasibility reviews for prospective clients

🎯 Requirements

• An RN, PT, OT, or SLP with an active, unrestricted clinical license • Bachelor's degree in Nursing, Therapy, Healthcare Administration, or a related field • 5+ years of progressive experience in Utilization Management, Clinical Operations, or health plan operations • 2+ years in a leadership or supervisory capacity • Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace UM • Knowledge of CMS regulations, NCQA accreditation, and delegation oversight • Experience partnering with Product and Technology teams to shape clinical workflows and digital solutions • Comfortable with hands-on execution, including writing documentation, testing workflows, building process tools, and managing details • Strong communication and stakeholder-influence skills • Master's degree, AI-enabled clinical workflow experience, InterQual® or MCG® familiarity, Lean/Six Sigma/Agile/PM certification, or prior UAT/QA experience are bonuses

🏖️ Benefits

• Fully remote opportunity with about 10% travel • Medical, dental, vision, life, disability insurance, and Employee Assistance Program • 401K retirement plan with company match • Flexible spending and health savings account • Flex Time Off + company holidays • Up to 14 weeks of paid parental leave • Pet insurance • Bonus included in total benefits package

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume