Company Overview:

Cohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patient’s healthcare experience, both in and out of the doctor’s office. Founded in August 2019, we are obsessed with eliminating wasteful friction that patients and doctors experience in areas that have nothing to do with health and treatment, particularly for diagnoses that require expensive procedures or medications. To that end, we build software that is expressly designed to ensure the appropriate plan of care is understood and expeditiously approved, so that patients and doctors can focus on health, rather than payment or administrative hassles.

Opportunity Overview:

We are looking for a Medical Director who will lead our Pain Management Associate Medical Directors and perform clinical reviews. Reporting to the Senior Medical Director for Cohere Health, and part of the review team that includes non-clinical intake specialists and nurses, this is a critical role in a Series B company that is rapidly scaling to impact millions of patients. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives. This is a permanent remote, full-time position.

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:

• Lead a team of Pain Management 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
• Perform clinical reviews on a daily basis (50%)
• Provide timely medical reviews that meet Cohere’s stringent quality parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen
• Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision
• Use correct templates for documenting decisions during case review
• Meet the appropriate turn-around times for clinical reviews
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
• Support the clinical guidelines team in developing and reviewing the company’s clinical decision guidelines in conjunction with client guidelines and directives
• Perform timely review of Medical Coverage Policies for our clients
• 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

Your Background and Requirements:

Required:

• Completed US-based residency program in Physical Medicine and Rehabilitation (PM&R) or Anesthesiology and fellowship program in Pain Management
• 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

Preferred:

• 2+ years of managed care utilization review experience
• 1+ years of direct supervision/management experience, preferably in a utilization management or payor organization
• Experience with clinical decision-making criteria sets (i.e., Milliman, InterQual)
• Membership in national and/or regional specialty societies
• Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX is highly desirable - you should be willing to obtain additional state licenses with Cohere's support

Competencies/Success Factors:

• Able to multitask and manage tasks to completion on a timely basis and in an organized fashion
• Excels in a matrix organization
• Strong interpersonal, oral and written communication skills
• Ability to work remotely and meet telephonically and/or via video with clinical colleagues and other personnel
• Proficient in using a Mac laptop computer and the Google Workspace of applications
• Comfortable with technology - willing and able to learn new software tools
• Understanding of managed care regulatory structure and processes
• Detail-oriented, flexible, and able to work autonomously with little supervision

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.

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