Clinical Policy Specialist

Remote 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: We are looking for a Clinical Policy Specialist who will support how this department scalably implements CMS, payer, and Cohere clinical policies within our product. This hire will have a direct impact on the lives of our clinicians and their patients. You’ll play a central role in our policy design and implementation process by reviewing policy content and ensuring it is configured within our product to optimize the clinical review of medical services. 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’ll do: Design and format clinical criteria across a range of medical specialty areas that meets product specifications and retains clinical accuracy Review healthcare policy documentation and data for discrepancies and missing information and resolve discrepancies Author healthcare policies including policy text, clinical indications, procedure codes, and diagnosis codes into Cohere Health’s product Monitor, review, and coordinate clinical policy updates Implement solutions that help our internal teams comply with medical service regulations Perform routine quality assurance checks in our product Prepare educational materials on policy updates for internal customers Contribute ideas on how to best organize and represent information based on internal customer and product needs Your background & requirements: Excellent clinical writing and editing skills Tech-savvy and detail-oriented Experience with clinical decision-making criteria sets (e.g., Milliman, InterQual) Strong interpersonal, oral and written communication skills Proficient in using a Mac laptop computer, GSuite and Gmail, Microsoft Excel and Microsoft Word You are passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible You are self-directed, confident, and thrive working in a fast-paced startup environment At least 2-5 years of clinical, regulatory, or scientific writing A Bachelors, Masters, PharmD or Ph.D. in a life science or health discipline, nursing preferred Minimum of one year of experience with prior authorization activities in a utilization management organization, experienced in writing policies or patient facing content (preferred) 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