Clinical Integrity Director

3 weeks, 1 day ago
Full-time
Senior
Project and Program Management
Cohere Health

Cohere Health

Cohere Health transforms healthcare utilization management and prior authorization, aligning physicians and health plans for better patient outcomes and reduced costs.

Insurance
251-1K
Founded 2019
$56M raised

Description

  • Own clinical integrity governance programs, including reviews, documentation, frameworks, checklists, tracking, and dashboards.
  • Manage clinical impact assessments for policy changes, product updates, and regulatory developments.
  • Own intake, prioritization, and delivery of clinical requirements to Product and Engineering teams.
  • Translate regulatory and clinical changes into product specifications while tracking timelines and dependencies.
  • Lead operational readiness for product releases and client implementations.
  • Manage clinical user acceptance testing, including test assignments, results review, defect triage, and resolution.
  • Develop readiness scorecards that provide go/no-go visibility for releases and implementations.
  • Coordinate clinical integrity activities across Product, Engineering, Clinical Operations, Compliance, and Client Success.
  • Prepare clinical integrity materials for RFPs, RFIs, and client questionnaires.
  • Lead clinical readiness activities and feasibility assessments for prospective and new client implementations.

Requirements

  • Active unrestricted clinical license as an RN, PT, OT, or SLP.
  • Bachelor’s degree in Nursing, Therapy, Healthcare Administration, or a related clinical discipline.
  • 7+ years of progressive experience in Utilization Management, Clinical Operations, or Health Plan operations.
  • 3+ years managing programs, projects, or teams.
  • Knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace utilization management.
  • Knowledge of CMS regulations, NCQA accreditation standards, and state regulatory requirements.
  • Experience managing concurrent cross-functional workstreams involving Product, Engineering, and Operations teams in technology-enabled environments.
  • Strong organizational, communication, problem-solving, accountability, and timeline-management skills.
  • Master’s degree in Healthcare Administration or Business Administration; Lean, Six Sigma, Agile, or PMP certification preferred.
  • Experience with clinical UAT programs, InterQual, MCG, or AI-enabled clinical workflows preferred.

Benefits

  • Fully remote role with approximately 10% travel and occasional Boston onboarding or team events.
  • Annual salary range of $159,000–$180,000, with bonus eligibility.
  • Medical, dental, vision, life, disability insurance, and Employee Assistance Program.
  • 401(k) with company match, flexible spending account, and health savings account.
  • Flexible time off and company holidays.
  • Up to 14 weeks of paid parental leave.
  • Pet insurance.

Interested in this position?

Apply directly on the company website

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