Company Overview:
Cohere Health is a fast-growing clinical intelligence company that’s improving lives at scale by promoting the best patient-specific care options, using cutting-edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health plans covering over 15 million lives, while our revenues and company size have quadrupled. That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include: 2023 and 2024 BuiltIn Best Place to Work; Top 5 LinkedIn™ Startup; TripleTree iAward; multiple KLAS Research Points of Light awards, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.
Opportunity Overview:
Working on a small, fast-paced team reporting into the Director of Commercial Strategy, you will help define the clinical strategy for Cohere’s inpatient solution, which combines deep clinical expertise and cutting edge AI to improve UM clinical review performance, reducing unnecessary IP admit utilization and operational burden. We’re seeking a seasoned health plan leader with extensive IP UM experience and a strong track record of reducing medical and admin spend through data-driven insights, clinical program development, and measurable outcomes. In this role, you’ll be responsible for identifying high-impact opportunities to improve IP UM, shaping innovative clinical programs in partnership with cross-functional teams, and continuously tracking performance to demonstrate value to our clients.
Last but not least: People who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.
What you will do:
- Monitor utilization trends and identify clinical drivers of unnecessary IP admit utilization and operational inefficiencies
- Help design targeted programs to improve medical necessity decision-making and reduce unnecessary IP admit admission utilization and operational inefficiencies
- Define and evolve the clinical framework that underpins the product, ensuring alignment with evidence-based guidelines and payer strategic priorities
- Translate clinical and regulatory requirements into clear inputs for analytics and product teams, supporting automated and scalable decision-making workflows
- Help identify, define, and track meaningful KPIs – generating actionable insights and clearly communicating measurable value to clients
- Act as a clinical and medical economics subject matter expert in strategic conversations with prospects and clients, reinforcing the credibility and differentiation of our solution
- Collaborate with client clinical and medical economics leaders to support solution implementation, validate clinical integrity, and ensure alignment with health plan goals
- Maintain deep knowledge of inpatient care trends, regulatory changes, and evolving payer strategies to continuously inform Cohere’s clinical approach
Your background & requirements:
- 10+ years of experience in IP UM at a health plan and / or IP revenue integrity at a hospital
- Clinical degree (e.g., RN, MD, PharmD) preferred but not required
- Proven track record designing and overseeing clinical programs that impact IP utilization and spend
- Strong grasp of IP utilization and spend, regulatory requirements, and clinical guidelines
- Experience collaborating with cross-functional teams (e.g., analytics, product, clinical operations) to translate clinical strategy into action
- Adept at interpreting complex data and identifying trends to inform clinical program design and evaluation
- Excellent communicator, able to convey clinical concepts clearly to both internal teams and external clients
- Ability to operate in fast paced startup environment
- Entrepreneurial by nature, always thinking about how to improve the status quo
- Passion for and conceptual understanding of how AI can be used to optimize UM
We can’t wait to learn more about you and meet you at Cohere Health!
Equal Opportunity Statement:
Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it’s personal.
The salary range for this position is $160,000 to $180,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.
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What We Do
Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.
With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.
Cohere Health’s innovations continue to receive industry-wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes.
Why Work With Us
Cohere Health brings together a community of healthcare and technology team members, passionate about changing the challenging parts of healthcare. If you enjoy solving challenging problems and learning about healthcare, then Cohere Health is a great career choice.
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Cohere Health Teams
Cohere Health Offices
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Employees work remotely.
Cohere employees work from 45 different states throughout the US - Cohere hosts retreats at our headquarters in Boston. ZignaAI, a Cohere Health Company, employees based in Hyderabad, India, work in-office 5 days a week.
