Clinical Policy Configuration Specialist

10 minutes ago
Full-time
Junior
Quality Assurance and Testing
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

  • Configure and maintain medical coverage policies within Cohere’s product platform.
  • Perform quality assurance reviews and testing of policy configurations to validate functionality and clinical appropriateness.
  • Monitor policy updates and adjust configurations to maintain compliance with current requirements.
  • Serve as a subject matter expert on medical coverage policies for internal teams and customers.
  • Respond to internal and external inquiries and feedback related to policy configurations.
  • Collaborate with clinical experts, product managers, engineers, medical writers, and utilization management reviewers to improve policy implementation and usability.

Requirements

  • 2+ years of related experience in utilization management, medical policy development, health technology assessment, or payer policy configuration.
  • Strong understanding of medical coverage policies and prior authorization criteria.
  • Familiarity with healthcare data structures and clinical coding systems, including ICD-10, HCPCS, and CPT.
  • Proficiency with Microsoft Word, Excel, Google Drive, Confluence, and Jira.
  • Strong attention to detail with experience in quality assurance and validation processes.
  • Ability to work independently and as part of a team.
  • Bachelor’s degree in Nursing (BSN) or equivalent clinical background.
  • Passion for improving the U.S. healthcare system and patient care.
  • Self-directed, confident, and comfortable in a fast-paced startup environment.

Benefits

  • Fully remote role with about 5% travel.
  • Medical, dental, vision, life, and disability insurance, plus an Employee Assistance Program.
  • 401(k) retirement plan with company match.
  • Flexible spending account and health savings account options.
  • Flex Time Off plus company holidays.
  • Up to 14 weeks of paid parental leave.
  • Pet insurance.
  • Annual salary range of $65,000 to $80,000, with bonus eligibility.

Interested in this position?

Apply directly on the company website

Apply Now

Similar Roles

Mission Analyst

Latitude AI 501-1000 information technology & services

Latitude AI is hiring a Fleet Operations Test Specialist to safely operate and monitor autonomous test vehicles that support the development of driving technology for Ford vehicles.

JIRA
10 minutes ago

Sr. Validation Engineer

Syner-G BioPharma 51-250 Professional Services

Syner-G is hiring a Senior Validation Engineer to lead GMP validation activities for equipment, systems, facilities, and manufacturing processes in biotech and pharmaceutical environments.

10 minutes ago

Parts Advisor, Millbrae

Lucid Motors 1K-5K Automotive

Lucid Motors is hiring a Parts Advisor to manage service center parts operations and inventory for efficient repairs and high customer satisfaction.

10 minutes ago

Logistics Specialist

Skyline Eco-Adventures 11-50 Hotels, Restaurants & Leisure

Zipline is hiring a Logistics Specialist to manage material, inventory, and fleet asset flow that keeps its maintenance hubs operating safely and efficiently.

ERP
10 minutes ago

You're on a roll! Sign up now to keep applying.

Sign Up

Already have an account? Log in

Used by 14,729+ remote workers