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:
Clinical Training & Quality Specialist will work in support of the Service Operations Team at Cohere Health who conduct reviews and decision Prior Authorization requests for a patient’s medical insurance . You will implement clinical training and quality processes, scoring, and performance improvement data designed to improve operational efficiency while exceeding industry standards for quality performance and clinical guidance. You will provide support to all functions within the Training & Quality department. With a solid foundation in Training and Quality, you are expected to be flexible and nimble in your role to manage short- and long-term projects as well as dealing with day-to-day tasks. Cohere culture is one of partnership and ownership.
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:
- Audit Individual Operations team members on Clinical decisions against clinical guidelines
- Facilitate training for the RN Clinical team on Cohere Clinical decisioning process and job functions
- Meet required audit counts
- Coach team members for improvement against quality metrics
- Provide reporting on performance and key areas of quality improvement to Sr Leadership
Your background & requirements:
- Active RN Licensure
- Experience in the process of Coverage Determinations in Healthcare
- NCQA and CMS standards for Utilization Management Authorization decisions
- LCD/NCD Coverage Determination
- Ability to conduct effective coaching sessions
- Understanding of Adult Learning Theory and Training RN
- Attention to detail
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 $70,000 to $80,000 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 and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With an enterprise approach that streamlines payer-provider decision-making across the care continuum–including policy, prior authorization, payment accuracy, and more–the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction. With the acquisition of ZignaAI, we 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 recognized on TIME’s World Top HealthTech Companies 2025 list, the 2025 Inc. 5000 list, in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024.
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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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.
