Clinical Training – Quality Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $70k - $78k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

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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

• Audit individual Operations team members on clinical decisions against clinical guidelines • Translate QA findings into insights and recommendations for operational leaders and cross-functional partners • Develop and deploy structured coaching sessions based on audit findings • Create and ensure accuracy of SOPs, job aids, workflow guides, and new product readiness materials • Facilitate onboarding and ongoing upskilling sessions for Clinical teams using adult learning principles and SME feedback • Lead the QA and Training aspects of project implementations by operationalizing workflow changes, quality expectations, and training updates • Partner with Product, Clinical, Client Services, and Operations to validate workflow changes and identify quality or compliance risks • Support change management by communicating process updates and aligning QA expectations across impacted teams • Serve as a subject matter expert and advisor to frontline leaders on quality trends, training needs, and operational readiness • Manage multiple concurrent priorities independently and remain accountable for deliverables • Step into operational queues as needed during high-volume periods to maintain service levels and continuity • Coach team members for improvement against quality metrics • Provide performance and quality-improvement reporting to senior leadership • Perform other duties as assigned

🎯 Requirements

• Active RN Licensure • 2+ years experience in the process of Coverage Determinations in Healthcare • Knowledge of NCQA and CMS standards for Utilization Management Authorization decisions • Knowledge of LCD/NCD Coverage Determination • Ability to conduct effective coaching sessions • Understanding of Adult Learning Theory and Training • Attention to detail • Verbal and written communication skills • Data collection, management and analysis • Problem analysis and problem solving • Planning and organizing • Effective interaction with stakeholders • Proficiency with Google Workspace (Sheets, Docs, Forms) • Ability to build pivot tables and create charts or dashboards is a plus • Experience identifying performance trends and root causes through data is a plus • Experience using quality management systems and conducting structured QA audits is a plus • Experience facilitating coaching sessions and giving constructive feedback is a plus

🏖️ 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 • Flexible Time Off • Company Holidays • Up to 14 weeks of paid parental leave • Pet insurance • Bonus included in total benefits package

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