Cohere Health is hiring a Remote Associate Medical Director Utilization Management
\nCompany Overview:\n\nCohere Health is a fast-growing clinical intelligence company thatโs 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 LinkedInโข 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.\n\nOpportunity Overview:\n\nWe are looking for physicians who have expertise in Internal Medicine including medical and surgical clinical areas to deliver on Cohereโs program by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. \n\nReporting to the Medical Director for Cohere Health, this is a critical role in a 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.\n\nLast 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.\n\nWhat you will do:\n\n\n* Support the clinical content team in reviewing the companyโs clinical decision guidelines and evidence based literature \n\n* Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes\n\n* Provide timely medical reviews that meet Cohereโs stringent quality and timeliness parameters\n\n* Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence based literature and medical society guidelines\n\n* 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\n\n* Use correct templates for documenting medical necessity decisions during case review\n\n* 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\n\n* Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers\n\n* Support projects specific to building the team's clinical expertise and efficiency, as delegated\n\n* Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated\n\n\n\n\nYour background & requirements:\n\nRequired:\n\n\n* Completed US-based residency program and fellowship in Internal Medicine\n\n* Board certification as an MD or DO with a current unrestricted state license to practice medicine - reviewers must maintain necessary credentials to retain the position\n\n* 5+ years of clinical practice beyond residency/fellowship in Internal Medicine\n\n* Excels in a matrix organization\n\n* Comfortable with technology - willing and able to learn new software tools\n\n* Understanding of managed care regulatory structure and processes\n\n* Consultant agrees to cooperate fully with Cohere by obtaining state licenses or registrations when requested by Cohere\n\n\n\n\nPreferred:\n\n\n* 2+ years of managed care utilization review experience desirable\n\n* Membership in national and/or regional specialty societies\n\n\n\n\n \n\nWe canโt wait to learn more about you and meet you at Cohere Health!\n\nEqual Opportunity Statement: \n\nCohere 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, itโs personal.\n\nThe salary range for this position is $200,000 to $270,000 annually, based on years of utilization management experience; 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.\n\n#LI-Remote\n\n#BI-Remote
\n\n#Benefits\n
๐ฐ 401(k)\n\n๐ Distributed team\n\nโฐ Async\n\n๐ค Vision insurance\n\n๐ฆท Dental insurance\n\n๐ Medical insurance\n\n๐ Unlimited vacation\n\n๐ Paid time off\n\n๐ 4 day workweek\n\n๐ฐ 401k matching\n\n๐ Company retreats\n\n๐ฌ Coworking budget\n\n๐ Learning budget\n\n๐ช Free gym membership\n\n๐ง Mental wellness budget\n\n๐ฅ Home office budget\n\n๐ฅง Pay in crypto\n\n๐ฅธ Pseudonymous\n\n๐ฐ Profit sharing\n\n๐ฐ Equity compensation\n\nโฌ๏ธ No whiteboard interview\n\n๐ No monitoring system\n\n๐ซ No politics at work\n\n๐ We hire old (and young)\n\n
\n\n#Location\nBoston, Massachusetts, United States
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