Company Overview:

Cohere Health is a fast-growing clinical intelligence company that’s improving lives at scale by promoting the best patient-specific care options, using leading edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health insurance plans covering over 15 million people, 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, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.

Opportunity Overview:

We are looking for a Strategic Program Manager, Physical Medicine who will be a cross-functional contributor on the Clinical Programs team, a consultant to our Clinical and Strategic Operations Team, and a clinical reviewer for physical medicine authorization requests. You will serve as a clinical representative of the company in interactions with our end-users which could include presenting to customers or having clinical conversations with Physical Therapists. In order to provide consultation to our operational leaders, you will need experience leading medical teams in an operational setting. This is a collaborative cross functional role that will provide clarity in a growing, complex organizational environment, generate energy through a bias towards action, and deliver results. Reporting to the Senior Director of Clinical Programs, you will design, implement, and scale programs in support of our larger clinical strategy. The work will be fast-paced with evolving needs - requiring flexibility, emotional intelligence, curiosity, and grace under pressure.

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:

In this role, you will serve as a leader for Clinical Programs and a consultant to Medical Operations. Cross-functional duties will include:

• Develop, communicate, and operationalize a clinical strategy for assigned Clinical Programs that position Cohere’s value given our unique assets and place in the market
• Work with product and content teams to devise a content framework that enables intake and decisioning of inpatient or outpatient authorizations; deeply understand workflow, data required, and code sets to enable automation
• Drive initiatives within Clinical Program to improve outcomes and value for patients, providers, and health plans, partnering with Trend Innovation, Clinical Quality and Analytics, clinicians, and product teams
• Develop strong relationships with prospects and clients to assess market needs, evangelize the Cohere approach and strategy, and ensure joint success
• Seeking Excellence - Ensure programs delivered meet the intended business benefits and/or success criteria by demonstrating leadership, initiative, and growth mindset
• Communication – Identify, engage, and manage all stakeholders including clearly identifying roles, articulating responsibilities, setting expectations, and resolving gaps and constraints effectively
• Implementation Success – Manage tasks and resources in a detailed project plan with accurate updates to implementation schedule provided regularly; utilize data to inform strategies that will drive meaningful change and demonstrate program impact and efficacy; lead post mortem reviews of implementation success
• Work cross functionally with VP, Physician Operations on workflow and process improvements
• Support the clinical guidelines team in developing and reviewing the Cohere proprietary clinical policies for Physical Medicine conjunction with client guidelines and directives
• As needed, you may be asked to provide timely expert medical review for physical medicine requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
• Performance of clinical reviews on a daily and weekly basis (up to 50% of the time) will enable you to be an advocate for Innovative Program design.
• Maintains necessary credentials and immediately informs Cohere of any adverse actions relating to medical licenses and/or board certifications.

Your background & requirements:

• A PT with a current, unrestricted U.S. state medical license (or able to obtain licensure within 30 days of hire)
• 5 or more years of direct clinical patient care experience
• 3 or more years of direct or indirect management experience, preferably in an utilization management organization within a Medicare, Commercial or Medicaid payor organization
• Deep understanding of Inpatient/Outpatient UM; expertise on inpatient acute hospital or outpatient patient flows, provider-payer workflows, or revenue cycle management
• Experience with NCQA accreditation
• Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual, LCD, NCD)
• 3-5 years of experience in Clinical Program design and implementation
• Deep understanding of healthcare data and excellent analytical abilities; comfort with Excel, Tableau
• High level of executive presence and proven track record and experience interfacing with external key business stakeholders/partners to achieve performance objectives
• Demonstrated track record of delivery and ability to independently manage tasks
• Passionate about continuous process improvement, always actively seeking out practical solutions to challenging business problems
• Strong leadership capabilities and ability to initiate and maintain cross-team relationships
• Strongly proficient in G-suite applications
• Proficient in developing presentations that tell a complete story

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 $120,000 to $130,000 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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