Jobs at Cohere Health

Leads inpatient clinical program strategy, innovation, and digital care management offerings for a healthcare technology company. Partners with clinical, product, engineering, analytics, operations, growth, and client experience teams to develop clinical logic, policy programs, technology-enabled solutions, and payer-facing strategies. Serves as a physician subject matter expert in client discussions, supports sales opportunities, builds partnerships, monitors program performance, and drives continuous improvement.

Leads clinical integrity governance and operational readiness programs across Clinical Operations, Product, Engineering, Compliance, and Client Success. Manages clinical requirements, regulatory change translation, product release readiness, clinical UAT, defect resolution, implementation planning, dashboards, and client-facing materials. Requires an active clinical license, extensive utilization management or health plan operations experience, and strong cross-functional program leadership in technology-enabled healthcare environments.

Own actuarial models and client-facing reporting measuring cost savings, outcomes, and performance of healthcare prior authorization programs. Analyze authorization and claims data, conduct impact evaluations, reconcile projected and realized results, investigate trends, and present executive-level insights to customers and leadership. Partner with clinical, customer success, data, and actuarial teams while maintaining reproducible, auditable methodology and documentation.

Develop and maintain financial and cost-savings models for prior authorization initiatives. Analyze healthcare claims, authorization trends, decision patterns, and cost drivers; quantify projected savings; and deliver executive reports and recommendations. Partner with clinical and customer success teams to address authorization challenges, conduct post-implementation assessments, and refine savings strategies. This remote-first role requires approximately 5% travel for onboarding and occasional meetings.

Deliver and improve live and digital training for client RN and MD reviewer teams using Cohere’s healthcare platform. Coordinate onboarding, develop LMS content and tailored training materials, document client workflows and customizations, host webinars and demos, and incorporate feedback to improve adoption. The role collaborates cross-functionally to maintain accurate training aligned with queue management processes and client operating models.

Own the full lifecycle of provider and client user engagement, including onboarding, training coordination, change enablement, proactive outreach, and relationship management. Serve as the primary provider contact, monitor portfolio performance, coordinate implementations, support prior authorization workflows, and recommend improvements that increase adoption, auto-approval rates, clinical quality, and compliance. Collaborate with internal teams, health plans, compliance, and legal while managing high-volume provider onboarding initiatives.

Leads clinical integrity for utilization management programs and technology-enabled healthcare solutions. Reviews workflows for regulatory and evidence-based alignment, writes clinical requirements and acceptance criteria, conducts UAT, manages release readiness, audits client commitments, and maintains governance documentation. Partners with clinical, product, engineering, compliance, legal, and client teams while supporting implementations, feasibility reviews, and business growth. Requires an active clinical license, healthcare operations expertise, and experience with Medicare, Medicaid, commercial, and marketplace utilization management.

Leads healthcare analytics projects using clinical, claims, pharmacy, and eligibility data to evaluate cost, utilization, quality, and program performance. Develops statistical analyses, predictive models, dashboards, and reporting solutions; identifies optimization opportunities; partners with clinical, product, engineering, and business teams; presents recommendations to stakeholders; and mentors junior analysts.

Audits clinical coverage decisions against guidelines, analyzes quality performance data, identifies trends and root causes, and provides coaching to Clinical Operations teams. Develops SOPs, job aids, workflow materials, onboarding, and upskilling sessions. Partners cross-functionally to implement workflow changes, manage quality and compliance risks, support change management, report improvement opportunities to leadership, and maintain operational coverage during high-volume periods.

Leads the L1 client support function, managing support associates, ticket triage, SLA tracking, escalations, access provisioning, client communications, and support metrics. Drives process improvements through automation, standardized workflows, alerting, and knowledge-base development. Partners with Client Success, Product, Engineering, and QA to resolve issues and improve the client support experience.

Reviews clinical information to determine medical appropriateness using evidence-based guidelines and clinical judgment. Documents medical necessity decisions, conducts peer-to-peer discussions with treating providers, supports clinical guideline development, and contributes to operational and member/provider experience improvements. The role requires an Internal Medicine physician with board certification, unrestricted licensure, managed care knowledge, strong communication skills, and the ability to work autonomously in a remote, matrixed environment.

Leads and develops a Data Platform engineering team while owning delivery of complex data initiatives. The role establishes delivery discipline, assesses technical and implementation risks, partners cross-functionally, and drives production reliability, data quality, observability, incident management, and on-call readiness. It also guides the evolution of scalable data ingestion, transformation, lakehouse, cloud architecture, governance, and reusable platform capabilities.

Consult PaaS clients on prior authorization decision automation programs, translating requirements into technical blueprints and partnering with Product, Design, Development, and Engineering. Build strategic improvement roadmaps, analyze healthcare authorization data, maintain dashboards and reports, monitor client KPIs, and ensure automation success throughout the customer lifecycle. The role also identifies scalable workflow improvements and guides customers in maximizing platform value.

Configures and tests clinical platform requirements for healthcare clients, defines test scenarios and success criteria, troubleshoots technical issues, and supports implementations. Serves as a configuration subject-matter expert for client-facing teams, collaborates with Product, Development, Design, and Engineering, and helps develop scalable configuration management tools.

Leads a 20-plus-person distributed Review Engineering organization across three agile squads. Owns technical direction, production reliability, incident response, system scalability, delivery metrics, hiring, performance management, and engineering career growth. Partners with Product, Design, Security, Clinical Operations, and peer engineering teams to deliver reliable, secure, high-quality systems in a regulated healthcare environment.

Designs and delivers large-scale, governed data pipelines and infrastructure across the full data lifecycle. Responsibilities include coding in Python and SQL, optimizing Airflow, dbt, AWS, Kafka, and Iceberg/Parquet workflows, implementing data quality and observability, contributing to architecture and tool evaluations, mentoring engineers, collaborating with stakeholders, and participating in on-call support.

Analyze administrative and clinical healthcare data to build reporting solutions, identify optimization opportunities, and support clinical program effectiveness. Apply statistical analysis, data mining, and predictive modeling to improve decision-making, patient outcomes, utilization, and cost efficiency. Develop dashboards and KPIs, monitor healthcare trends, collaborate with clinical, data science, engineering, and client teams, and lead complex multidisciplinary projects.

Reviews therapy services for medical appropriateness using evidence-based guidelines and clinical judgment. Conducts timely utilization reviews, documents medical necessity decisions, participates in peer-to-peer discussions with treating providers, and supports clinical guideline development, team expertise, operational improvements, and member/provider experience. Requires expertise in PM&R, Family Practice, Pediatrics, or Internal Medicine and knowledge of PT, OT, and SLP programs.

The Associate Medical Director oversees clinical reviews for orthopedic services, ensuring evidence-based guidelines are applied and communication is effective. Responsibilities include peer discussions for clinical clarity, documentation, and supporting operational improvements, requiring extensive experience in orthopedic surgery and managed care.

This role involves reviewing clinical information, providing medical determinations in Cardiovascular Medicine, and ensuring high-quality patient outcomes through evidence-based guidelines. The Medical Director collaborates with teams to enhance clinical practices and manages operational improvements.