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Leads clinical integrity governance and operational readiness programs across Clinical Operations, Product, Engineering, Compliance, and Client Success. Manages clinical requirements, regulatory change translation, product release readiness, clinical UAT, defect resolution, implementation planning, dashboards, and client-facing materials. Requires an active clinical license, extensive utilization management or health plan operations experience, and strong cross-functional program leadership in technology-enabled healthcare environments.

Own actuarial models and client-facing reporting measuring cost savings, outcomes, and performance of healthcare prior authorization programs. Analyze authorization and claims data, conduct impact evaluations, reconcile projected and realized results, investigate trends, and present executive-level insights to customers and leadership. Partner with clinical, customer success, data, and actuarial teams while maintaining reproducible, auditable methodology and documentation.

Develop and maintain financial and cost-savings models for prior authorization initiatives. Analyze healthcare claims, authorization trends, decision patterns, and cost drivers; quantify projected savings; and deliver executive reports and recommendations. Partner with clinical and customer success teams to address authorization challenges, conduct post-implementation assessments, and refine savings strategies. This remote-first role requires approximately 5% travel for onboarding and occasional meetings.

Deliver and improve live and digital training for client RN and MD reviewer teams using Cohere’s healthcare platform. Coordinate onboarding, develop LMS content and tailored training materials, document client workflows and customizations, host webinars and demos, and incorporate feedback to improve adoption. The role collaborates cross-functionally to maintain accurate training aligned with queue management processes and client operating models.

Leads healthcare analytics projects using clinical, claims, pharmacy, and eligibility data to evaluate cost, utilization, quality, and program performance. Develops statistical analyses, predictive models, dashboards, and reporting solutions; identifies optimization opportunities; partners with clinical, product, engineering, and business teams; presents recommendations to stakeholders; and mentors junior analysts.

Leads and develops a Data Platform engineering team while owning delivery of complex data initiatives. The role establishes delivery discipline, assesses technical and implementation risks, partners cross-functionally, and drives production reliability, data quality, observability, incident management, and on-call readiness. It also guides the evolution of scalable data ingestion, transformation, lakehouse, cloud architecture, governance, and reusable platform capabilities.

Leads a 20-plus-person distributed Review Engineering organization across three agile squads. Owns technical direction, production reliability, incident response, system scalability, delivery metrics, hiring, performance management, and engineering career growth. Partners with Product, Design, Security, Clinical Operations, and peer engineering teams to deliver reliable, secure, high-quality systems in a regulated healthcare environment.

Designs and delivers large-scale, governed data pipelines and infrastructure across the full data lifecycle. Responsibilities include coding in Python and SQL, optimizing Airflow, dbt, AWS, Kafka, and Iceberg/Parquet workflows, implementing data quality and observability, contributing to architecture and tool evaluations, mentoring engineers, collaborating with stakeholders, and participating in on-call support.

Lead end-to-end technical integrations with enterprise healthcare customers from pre-sales through production. Scope and deliver architecture, POCs, API integrations, data mappings, and runbooks. Ensure AI/ML features meet regulatory and clinical safety standards, build reusable integration patterns, collaborate cross-functionally, and mentor junior engineers to drive successful go-lives.

Lead technical analysis and design of healthcare interoperability solutions, defining data exchanges and integration workflows (APIs, HL7, X12, SFTP). Conduct client discovery, produce mappings and interface specs, investigate failures, develop tests, manage multiple implementations, support launches and steady-state operations, and mentor junior analysts.