Manager, Clinical Escalations

Job not on LinkedIn

🔥 4 minutes ago

🇺🇸 United States – Remote

💵 $116k - $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.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.

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

• Design and implement a formal escalation framework, including intake processes, triage criteria, severity classifications, tracking mechanisms, and reporting cadences • Transition the escalation function from the Client Success team into a dedicated program • Serve as the primary point of accountability for incoming client and provider escalations • Categorize, assign, and resolve escalations according to defined workflows • Monitor open escalations and ensure follow-up actions are completed and documented • Hold internal teams accountable for timely closure • Track and enforce regulatory and contractual response-time requirements • Flag risks and implement corrective actions when turnaround times are at risk • Manage sensitive executive-level client or provider escalations • Communicate escalation risks to Cohere leadership • Manage, coach, and support one direct report, the Escalations Analyst • Develop dashboards and reporting on escalation volume, resolution rates, turnaround-time compliance, root causes, and trends • Partner with Client Success, Clinical Operations, Compliance, Product, Clinical Content, and other teams to address systemic issues • Create and maintain SOPs, escalation playbooks, and communication templates

🎯 Requirements

• Bachelor's degree in healthcare • Active clinical licensure in state of residence (RN, PT/OT/SLP considered) • 3+ years of experience in utilization management operations • Experience in external client, provider, and/or member communications • Knowledge of healthcare regulations and accreditation (CMS, Medicaid, JCAHO) • Proficiency with spreadsheet functions, including data analysis and drawing quantitative conclusions • Experience implementing process improvements • Ability to function independently and navigate ambiguity to build a cross-functional program • Strong problem-solving skills with a customer focus • Passion for improving the U.S. healthcare system and helping ensure every patient receives the best care possible • Familiarity with ticketing or project management software (e.g., CRM, JIRA, Monday.com) is a plus • Demonstrated success implementing new programs is a plus • People leadership experience is a plus • Experience managing escalations in a multi-client or multi-health-plan environment is a plus • Familiarity with root cause analysis (RCA) methodologies and corrective action plan (CAP) development is a plus

🏖️ 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