Medical Director, Utilization Management

🔥 15 minutes ago

🇺🇸 United States – Remote

💵 $240k - $250k / 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 the company’s clinical decision guidelines and evidence-based literature • Provide expert input on content for influencing physicians in medical care to improve patient outcomes • Provide timely medical reviews meeting quality and timeliness parameters • Provide clinical determinations using evidence-based criteria, clinical acumen, medical society guidelines, and evidence-based literature • Document communication 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 • Demonstrate professionalism, accountability, and service in interactions with teammates and providers • Support projects building the team’s clinical expertise and efficiency • Support operational improvements and member/provider experience involving clinical review tasks

🎯 Requirements

• Completed US-based residency program and fellowship in 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 Internal Medicine • Ability to excel in a matrix organization • Comfortable with technology and willing and able to learn new software tools • Understanding of managed care regulatory structure and processes • Detail-oriented, flexible, and able to work autonomously with little supervision • 1+ years of managed care utilization review experience desirable • Membership in national and/or regional specialty societies preferred • Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX highly desirable • Willingness to obtain additional state licenses with Cohere's support

🏖️ 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

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