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 doctors office.  Founded in August, 2019, we are obsessed with eliminating wasteful friction 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:

This role will be primarily responsible for performing MD compliance audits to ensure compliance with federal and state regulations as well as NCQA and client contractual requirements.  

The Compliance Auditor will plan, coordinate, and conduct compliance audits at the direction of the Compliance Officer and Quality Committee.  Scope will include primarily auditing of MD output against applicable rules and regs.  Will also include review / auditing of all CMS required data tables, utilization management determinations and associated clinical rationale.  Key function will be to coordinate with external audit functions.

Role will retroactively identify areas of compliance risk and vulnerability, provide feedback and coaching to the Clinicians team, as appropriate, and serve as a resource on issues related to corporate compliance and appropriate business practices.

At a growing organization, this is a position that offers the ability to make a substantive mark on the company and its partners with exponential growth opportunity. You will be part of the data management team and build one Cohere data platform to support our downstream teams to optimize patient care paths.

Essential Job Functions:

• Ensures compliance with regulations by examining and analyzing records, reports, operating practices, and documentation; will provide recommendations for improvement and coaching as necessary.
• Completes audit work papers and memorandums by documenting audit findings.  
• Presents audit findings to the Quality Committee or other leadership body.
• Maintains excellent documentation of all audits, methodologies employed, results, corrective action plans implemented, and monitoring.
• Communicates audit progress and findings by preparing reports, discussions with management and providing information in meetings.
• Participates in all third party audits as the first level, client facing contact.  Coordinates with Client auditors to ensure smooth knowledge transfer and audit process
• Assists in the development of Compliance policies and procedures.
• Maintains a strong working knowledge of state and federal legislation, statutes and regulations, as well as various client service level agreements.
• Provide UM RN review / audit support as necessary.  

Education and Experience

• Completion of an accredited Registered Nurse Program.  
• Minimum 2 years in a Health Care Audit role, preferably in clinical review.  

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.

#LI-Remote

#BI-Remote