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Clinical Training & Quality Specialist

16 hours, 35 minutes ago
United States
Full-time
Junior
Manual QA Tester
Quality Assurance and Testing
Apply Now
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
View All Jobs 12

Description

  • Audit Clinical Operations team members’ clinical decisions against guidelines, including coverage determination standards.
  • Analyze quality findings and provide insights, recommendations, and performance reports to operational and senior leaders.
  • Develop and deliver coaching sessions to improve accuracy, decision-making, and performance against quality metrics.
  • Create and maintain accurate SOPs, job aids, workflow guides, and product-readiness materials.
  • Facilitate onboarding and ongoing clinical training using adult learning principles and subject-matter expertise.
  • Lead the QA and training components of project implementations, including workflow changes and updated quality expectations.
  • Partner with Product, Clinical, Client Services, and Operations teams to validate workflows and identify quality or compliance risks.
  • Support change management by communicating process updates and aligning QA expectations across teams.
  • Serve as a subject-matter expert to frontline leaders on quality trends, training needs, and operational readiness.
  • Manage concurrent projects independently and support operational queues during high-volume periods as needed.

Requirements

  • Active RN licensure.
  • 2+ years of experience with healthcare coverage determinations.
  • Knowledge of NCQA and CMS standards for Utilization Management authorization decisions.
  • Knowledge of LCD/NCD coverage determinations.
  • Ability to conduct effective coaching sessions and provide constructive feedback.
  • Understanding of adult learning theory and clinical training.
  • Strong verbal and written communication, attention to detail, problem-solving, planning, and organization skills.
  • Experience with data collection, management, analysis, and stakeholder interaction.
  • Proficiency with Google Workspace, including Sheets, Docs, and Forms; pivot tables, charts, or dashboards are a plus.
  • Experience with quality management systems, structured QA audits, and identifying performance trends or root causes is preferred.

Benefits

  • Fully remote role with approximately 5% travel.
  • $70,000–$78,000 annual salary, 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

Apply Now

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