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 doctor’s office. Founded in August 2019, we are obsessed with eliminating wasteful friction that 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 physicians who have expertise in sleep medicine to deliver on Cohere’s program by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines.

Reporting to the Chief Medical Officer for Cohere Health, this role will be a fundamental physician driver of new clinical program design, strategy, and innovation – working closely with prospective and current clients as we rapidly expand . As the internal subject matter expert in one or more clinical specialties, you will support go-to-market efforts with the Growth team by evangelizing Cohere’s vision and understanding the pain points and needs of Cohere’s clients (i.e., health plans, health systems, & ACOs). You will also collaborate cross-functionally to shape and execute the clinical strategy so that Cohere successfully fills those needs using our core technologies and services. At a growing organization, this is a position that offers the ability to make a substantive mark on the company, and its partners, and the healthcare system.

The ideal candidate will have a deep understanding of the health plan market and proven success in clinical, care management, or similar strategic roles supporting the successful execution of consultative engagements designing programs for current and existing clients. Most importantly, this exciting new role requires a physician leader who can think strategically and is equally strong in driving execution as we develop and launch new clinical and care management offerings. The work will be fast-paced with evolving needs, requiring flexibility, emotional intelligence, curiosity, and grace under pressure.

What You Will Do:

• Lead the vision and evolution of the company’s clinical and digital care management offerings as the clinical subject matter expert, in collaboration with colleagues from Clinical Strategy, Analytics, Product Management, Operations, Growth, and other teams
• Utilizing market data, consumer research, and patient analytics, spearhead new approaches to effective clinical delivery services, including the introduction of new technology and integrated paths.
• Provide physician leadership in the creation of comprehensive research packages, investigating specific clinical areas/offerings and strategic partners of interest to strengthen the offering. Then, execute on cultivating any external partnerships and/or vendor relationships as necessary
• Create and expand client relationships by partnering with the Growth team to uncover client pain points and deliver solutions
• Participate in the strategic planning for Cohere’s clinical and digital care management strategy
• Provide strategic guidance of utilization management and medical policy programs/areas as necessary to support the clinical organization
• Monitor performance of launched clinical programs and support continuous improvement
• Support the clinical content team in reviewing the company’s clinical decision guidelines and evidence based literature
• Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes
• Provide timely medical reviews that meet Cohere’s stringent quality and timeliness parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence based literature and medical society guidelines
• Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision
• Use correct templates for documenting medical necessity decisions during case review
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
• Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers
• Support projects specific to building the team's clinical expertise and efficiency, as delegated
• Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated

Your Background and Requirements:

• Completed US-based residency program in Internal Medicine and a fellowship in Sleep Medicine.
• Board certification as an MD or DO with a current unrestricted state license to practice medicine and must maintain necessary credentials to retain the position
• 5+ years of clinical practice beyond residency/fellowship in Internal Medicine/Pulmonary Medicine/Sleep Medicine.
• 3+ years of managed care utilization review experience
• Membership in national and/or regional specialty societies
• 3+ years experience in managed care or clinical strategy at a health plan, healthtech/solutions/services, expert consulting (partner-level), or related payer-facing roles
• Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX is highly desirable - you should be willing to obtain additional state licenses with Cohere's support
• Able to multitask and manage tasks to completion on a timely basis and in an organized fashion
• Excels in a matrix organization
• Excellent communication - written and spoken
• Comfortable with technology - willing and able to learn new software tools
• Understanding of managed care regulatory structure and processes
• Detail-oriented, flexible, and able to work autonomously with little supervision

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.

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