Clinical Policy Configuration Specialist
New
C
Cohere HealthHealth Technology
United StatesFull-TimeMiddle
Salary65,000 - 80,000 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- 2+ years
- Required Skills
- JiraMicrosoft ExcelQuality AssuranceConfluence
Requirements
- 2+ years of related experience working in utilization management, medical policy development, health technology assessment, or payer policy configuration.
- Strong understanding of medical coverage policies and prior authorization criteria.
- Familiarity with healthcare data structures, and clinical coding (ICD-10, HCPCS, CPT).
- Must be knowledgeable of multiple software programs (Microsoft Word, Excel, Google Drive, Confluence, Jira).
- Strong attention to detail with experience in quality assurance and validation processes.
- Ability to work independently and as part of a team.
- Bachelor's Degree in Nursing (BSN) or equivalent clinical background.
Responsibilities
- Configure and maintain medical coverage policies within Cohere’s product platform to ensure accuracy, consistency, and compliance with industry standards.
- Conduct quality assurance reviews and testing of policy configurations to validate functionality and clinical appropriateness.
- Monitor updates on medical coverage policies to adjust policies and maintain compliance.
- Serve as a subject matter expert on medical coverage policies, providing guidance and support to internal teams and customers.
- Address internal/external customer inquiries and feedback regarding policy configurations, ensuring alignment with payers, providers, and reviewers.
- Collaborate cross-functionally with clinical experts, product managers, engineers, medical writers, and utilization management reviewers to optimize policy implementation and usability.
View Full Description & ApplyYou'll be redirected to the employer's site
