Clinical Policy Configuration Specialist

2 weeks 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

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