Clinical Policy Configuration Specialist

🔥 9 minutes ago

🏄 California, New York, +1 more states – Remote

🏄 California – Remote 🗽 New York – Remote ☕ Washington – Remote

💵 $65k - $80k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Configure and maintain medical coverage policies within Cohere’s product platform • Conduct quality assurance reviews and testing of policy configurations • Monitor updates on medical coverage policies and adjust policies to maintain compliance • Serve as a subject matter expert on medical coverage policies, providing guidance and support to internal teams and customers • Address internal and external customer inquiries and feedback regarding policy configurations • Collaborate with clinical experts, product managers, engineers, medical writers, and utilization management reviewers to optimize policy implementation and usability

🎯 Requirements

• 2+ years of related experience working in utilization management, medical policy development, health technology assessment, or payer policy configuration • Strong understanding of medical coverage policies and prior authorization criteria • Familiarity with healthcare data structures and clinical coding (ICD-10, HCPCS, CPT) • Must be knowledgeable of Microsoft Word, Excel, Google Drive, Confluence, and Jira • Strong attention to detail with experience in quality assurance and validation processes • Ability to work independently and as part of a team • Passion for improving the U.S. healthcare system and helping ensure every patient receives the best care possible • Self-directed, confident, and able to thrive in a fast-paced startup environment • Bachelor's Degree in Nursing (BSN) or equivalent clinical background • This role is not eligible for hire in CA, NY, or WA

🏖️ Benefits

• Fully remote opportunity with about 5% 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 the total benefits package

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