RN Reviewer

Job not on LinkedIn

🔥 3 minutes ago

🇺🇸 United States – Remote

💵 $33 - $35 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 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

• Perform prospective review (prior authorization), admission, concurrent, and retrospective reviews • Determine the medical appropriateness and necessity of clinical requests from providers • Assess inpatient admissions, outpatient services and procedures, and out-of-network provider requests • Review Commercial, Medicare, and Medicaid lines of business • Collaborate with Medical Directors and providers on clinical decisions • Document reviews accurately and meet production and quality goals • Apply MCG, Cohere, and coverage guidelines for compliance and consistency • Partner with Operations, Product, Quality, and Health Plans teams to improve processes and outcomes • Identify opportunities for care management or quality improvement programs • Support accreditation, regulatory, and quality initiatives

🎯 Requirements

• Active, unencumbered RN license in the state of residence • 3+ years of clinical experience • Utilization Management experience • Experience in acute or post-acute settings • Solid understanding of utilization and case management programs • Knowledge of NCQA/CMS standards • Proficiency with MCG; CareWebQI is a plus • Comfortable using Mac and Google Workspace • Strong communication and collaboration skills across remote teams • Customer-focused mindset and ability to stay calm under pressure • Adaptability in a fast-moving startup environment • Organized, detail-oriented, and able to manage multiple priorities • Bachelor's degree in Nursing, Business, or related field • Robust internet speeds above 50 megabytes/second, including ability to use Zoom and stream video • Preferred: HEDIS abstraction, Legal RN, or Utilization Review background

🏖️ Benefits

• Fully remote opportunity with about 5% travel • Medical, dental, vision, life, and disability insurance • Employee Assistance Program • 401K retirement plan with company match • Flexible spending account • Health savings account • Up to 184 hours (23 days) of PTO per year plus company holidays • Up to 14 weeks of paid parental leave • Pet insurance • Bonus included in the total benefits package

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