Cohere Health

๐Ÿ‘ฅ 501-1000๐Ÿ’ฐ $50,000,000 Series C about 1 year agoSaaSConsumer SoftwareHealth CareSoftware๐Ÿ’ผ Private Company
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Cohere Health is a technology-focused company that engages in the development and implementation of innovative solutions in the health sector, seeking to optimize healthcare delivery and improve patient outcomes.

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๐Ÿ“ United States

๐Ÿงญ Full-Time

๐Ÿ’ธ 270000.0 - 295000.0 USD per year

๐Ÿ” Healthcare

  • Completed US-based residency program in Orthopedic Surgery; Spine surgery fellowship training or extensive clinical experience required
  • Board certification as an MD or DO with a current unrestricted state license to practice medicine - must maintain necessary credentials to retain the position
  • 5+ years of clinical practice beyond residency/fellowship
  • Lead a team of Orthopedic Surgery and Spine Surgery Associate Medical Directors responsible for prior authorization clinical reviews and peer-to-peer discussions
  • Inspire and motivate team members to perform at their best
  • Demonstrated ability to oversee and collaborate with staff
  • Proven experience managing a remote workforce and operating efficiently in a virtual environment
  • Identify potential problems and points of friction and working to find solutions in order to maximize efficiency and revenue
  • Develop and document standard operating procedures
  • Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers
  • Support the clinical guidelines team in developing and reviewing the companyโ€™s clinical decision guidelines in conjunction with client guidelines and directives
  • Perform timely review of Medical Coverage Policies for our clients
  • Participate in internal and external audits of physicians and nurses
  • Participate in recruiting of AMDs as business needs grow
  • Participate in developing and implementing of physician training
  • Support MSK strategy team focused on Spine strategy. This includes new strategy around site of service, level of care, temporary codes, G&A alignment, policy work and other areas such as reviewer efficiency enhancements, client facing meetings, etc.
  • Help to promote and maintain professional relationships or partnerships with Spine medical specialty societies, specifically NASS.
  • Be willing to travel as needed for client facing meetings or strategic onsite meetings
  • Maintain awareness of any changes in the literature, standard of care, or regulatory guidance impacting the criteria by which the company reviews service requests
  • Maintain necessary credentials and immediately informs Cohere of any adverse actions relating to medical licenses and/or board certifications
  • Perform other duties as delegated

LeadershipProject ManagementPeople ManagementOperations ManagementCommunication SkillsAnalytical SkillsOrganizational skillsInterpersonal skillsClient relationship managementStrategic thinking

Posted 22 days ago
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๐Ÿ”ฅ Product Manager
Posted 2 months ago

๐Ÿ“ United States, Canada

๐Ÿงญ Full-Time

๐Ÿ’ธ 120000.0 - 145000.0 USD per year

๐Ÿ” Digital Health

  • Minimum of 3 years of experience in product management in care management, digital health, or adjacent industries with a focus on driving efficiencies in clinical workflows at scale.
  • Track record of โ€œ0 to 1โ€ product experience, with the ability to synthesize complex insights and run experiments to develop a product strategy for the team.
  • Proven experience synthesizing business and customer needs to independently form (and execute on) a product roadmap.
  • Exceptional analytical capabilities and a dogged determination to always make decisions and validate hypotheses informed by data.
  • Strong problem-solving skills and willingness to roll up oneโ€™s sleeves to get the job done.
  • Demonstrated ability to lead and mentor cross-functional teams in a matrix organization.
  • Work with the Review Product Lead to prioritize initiatives that address the highest impact opportunities to drive more efficiency and better decision making in Nurse and Medical Director workflows.
  • Independently align stakeholders, research, design and engineering to execute against your roadmap.
  • Leverage data-driven insights, a deep knowledge of your end users, and collaboration with Cohereโ€™s RNs and MDs to deliver automation at scale.
  • Gain a deep understanding of the decisions made by patients, providers, and payers that leads to how patient care is delivered. Translate user pain points into actionable opportunities with measurable impact.
  • Work closely with Design, Product Engineering, Machine Learning, Data Science, and User Research teams to deliver solutions that have demonstrable and measurable impact.
  • Define key success metrics and ensure all solutions are measurable to demonstrate value to both internal and client stakeholders.
  • Act as a product evangelist of Cohereโ€™s Review product to both internal stakeholders and client leadership.

Data AnalysisMachine LearningProduct ManagementCross-functional Team LeadershipStakeholder management

Posted 2 months ago
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๐Ÿ”ฅ RN Reviewer
Posted 3 months ago

๐Ÿ“ United States

๐Ÿ’ธ 32.0 - 35.0 USD per hour

๐Ÿ” Clinical intelligence

  • Registered Nurse with active, unencumbered license in state of residence.
  • Minimum 3 years of clinical experience.
  • Required Utilization Management experience.
  • Experience in acute care and/or post-acute care environments.
  • Preferred experience includes HEDIS RN/abstraction, Legal RN, Utilization Review.
  • Strong communication skills, both written and oral.
  • Understanding of NCQA and CMS standards.
  • Proficient in using MCG guidelines.
  • Performs medical necessity review including inpatient, concurrent, prior authorization, retrospective, and treatment setting reviews.
  • Consults with Medical Directors regarding care that does not meet criteria.
  • Documents clinical information accurately and timely.
  • Maintains understanding of Cohere Healthโ€™s authorization and clinical criteria.
  • Identifies and refers members to appropriate healthcare programs.
  • Collaborates and educates with various stakeholders to ensure criteria consistency.
  • Ensures compliance with accreditation and regulatory requirements.
  • Participates in quality improvement activities.
Posted 3 months ago
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๐Ÿ“ United States

๐Ÿ’ธ 33.0 - 35.0 USD per hour

๐Ÿ” Clinical intelligence

  • Registered Nurse with active, unencumbered license in the state of residence.
  • Minimum of 3 years of clinical experience.
  • Utilization Management experience is required.
  • MCG certification is preferred.
  • Experience in acute or post-acute care environments is desired.
  • Understanding of NCQA and CMS standards.
  • Excellent written and oral communication skills.
  • Performs medical necessity review including inpatient, concurrent, prior authorization, and retrospective reviews to ensure appropriateness and compliance.
  • Communicates consistently with providers and facility staff to meet member needs.
  • Documents clinical information completely, accurately, and timely.
  • Maintains understanding of authorizations and clinical criteria.
  • Identifies clinical program opportunities and refers to healthcare programs.
  • Collaborates with various teams to ensure application of clinical criteria.
  • Ensures compliance with accreditation and regulatory requirements.
  • Supports quality improvement activities.
Posted 3 months ago
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๐Ÿงญ Full-Time

๐Ÿ’ธ 100000.0 - 115000.0 USD per year

๐Ÿ” Healthcare

  • 5+ years experience working in an analyst role
  • Ability to use statistical analysis tools (such as SQL, R, or SAS) to extract insights from complex healthcare data sets, interpret trends, and derive actionable recommendations - experience with Athena preferred
  • 1+ years experience building and/or maintaining dashboards and self service business intelligence tools such as Tableau or PowerBI
  • Understanding of healthcare systems, medical terminologies, clinical workflows, and regulations preferred
  • Experience interfacing with internal stakeholders and colleagues on the development and definition of client and program specific KPIs
  • Strong verbal and written communication skills will be essential to convey complex information to stakeholders and collaborate effectively with internal stakeholders and clients
  • Experience setting goals and meeting deadlines for multiple ongoing projects
  • Ability to identify issues within healthcare data and devise solutions
  • Ability to navigate ethical dilemmas in healthcare data management and analysis while upholding professional standards and integrity
  • Research, Build, Execute and Optimize auto decisioning strategy for new client implementations
  • Work with multiple types of healthcare data to build and maintain analytical and reporting solutions to support strategy and program decision making
  • Identify optimization opportunities based on analyses to improve auto-decisioning performance and drive increased value for clients
  • Perform quantitative analysis of health care cost, operational performance and clinical outcomes using claims and authorization data
  • Track cost, utilization and industry trends to inform stakeholders of solution performance and provide insights around opportunities to optimize clinical value for patients, providers and payers.
  • Prepare information for clients, build reports, data visualization and self service solutions for internal and external stakeholders
  • Develop, review, and analyze detailed data sets leveraged for client reporting/analytics
  • Collaborate with Insights team on rule refinement and metric tracking

Data visualization

Posted 4 months ago
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