Clinical Training & Quality Specialist

Cohere HealthHealthcare Technology

Location: United StatesFull-TimeMiddle

Salary70,000 - 78,000 USD per year

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Job Details

Experience: 2+ years experience in the process of Coverage Determinations in Healthcare
Required Skills: Data AnalysisChange ManagementGoogle Workspace

Active RN Licensure.
2+ years experience in the process of Coverage Determinations in Healthcare.
Understanding of NCQA and CMS standards for Utilization Management Authorization decisions.
Understanding of LCD/NCD Coverage Determination processes.
Ability to conduct effective coaching sessions.
Understanding of Adult Learning Theory and Training.
Strong attention to detail and communication skills (verbal and written).
Proficiency with Google Workspace (Sheets, Docs, Forms).
Ability to build pivot tables and create charts or dashboards.
Data collection, management, and analysis skills.

Audit Individual Operations team members on Clinical decisions against clinical guidelines.
Translate QA findings into clear insights and recommendations for operational leaders and cross-functional partners.
Develop and deploy structured coaching sessions based on audit findings to improve accuracy, decision-making, and skill development.
Create and ensure accuracy of SOPs, job aids, workflow guides, and new product readiness materials.
Facilitate onboarding and ongoing upskilling sessions for Clinical teams using adult learning principles and SME feedback.
Lead QA/Training side of project implementations by operationalizing workflow changes, quality expectations, and training updates into the business.
Partner with Product, Clinical, Client Services, and Operations to validate workflow changes and identify potential quality or compliance risks.
Support change management by communicating process updates and aligning QA expectations across impacted teams.

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