Medical Director – Therapy

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $210k - $260k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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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

• Support the clinical content team in reviewing clinical decision guidelines and evidence-based literature • Provide expert input on content intended to influence physicians and improve patient outcomes • Provide timely medical reviews meeting quality and timeliness parameters • Make clinical determinations using evidence-based criteria, clinical acumen, medical literature, and medical society guidelines • Clearly document communications and decision-making in Cohere workflow tools • Use correct templates for documenting medical necessity decisions during case review • Conduct peer-to-peer discussions with treating providers to clarify clinical information and explain review outcomes • Provide feedback on alternate treatment based on medical necessity criteria and evidence-based research • Maintain professionalism, accountability, and service in interactions with teammates and providers • Support projects that build team clinical expertise and efficiency • Support operational improvements and member/provider experience related to clinical review tasks

🎯 Requirements

• Completed US-based residency program in PM&R, Family Practice, Pediatrics, or Internal Medicine • Board certification as an MD or DO • Current unrestricted state license to practice medicine; reviewers must maintain necessary credentials to retain the position • 5+ years of clinical practice beyond residency/fellowship in the listed specialties • Understanding of Therapy programs (PT / OT / SLP) on outpatient and inpatient basis • Understanding of managed care regulatory structure and processes • Comfortable with technology and willing and able to learn new software tools • Ability to excel in a matrix organization • Detail-oriented, flexible, and able to work autonomously with little supervision • 1+ years of managed care utilization review experience in Therapy (PT/OT/SLP) highly desirable • Licensure in AR, MO, MN, NC, IN, TX, NE highly desirable; willingness to obtain additional state licenses with Cohere's support

🏖️ 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 as part of the total benefits package