Associate Medical Director, Utilization Management - Remote

Overview

Cohere Health is a fast-growing clinical intelligence company that’s improving lives at scale by promoting the best patient-specific care options, using cutting-edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health plans covering over 15 million lives, while our revenues and company size have quadrupled. That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include: 2023 and 2024 BuiltIn Best Place to Work; Top 5 LinkedIn™ Startup; TripleTree iAward; multiple KLAS Research Points of Light awards, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.

In Short

• Support the clinical content team in reviewing clinical decision guidelines.
• Provide expert input on content for influencing physicians in medical care.
• Conduct timely medical reviews that meet quality and timeliness parameters.
• Document all communication and decision-making in workflow tools.
• Use correct templates for documenting medical necessity decisions.
• Conduct peer-to-peer discussions with treating providers.
• Demonstrate professionalism and accountability in interactions.
• Support projects to build clinical expertise and efficiency.
• Assist in operational improvements involving clinical review tasks.

Requirements

• Completed US-based residency program and fellowship in Internal Medicine.
• Board certification as an MD or DO with a current unrestricted state license.
• 5+ years of clinical practice beyond residency/fellowship.
• Excels in a matrix organization.
• Comfortable with technology and learning new software tools.
• Understanding of managed care regulatory structure.
• Willing to obtain state licenses or registrations as requested.
• Weekend coverage on a rotating basis required.

Benefits

• Health insurance.
• 401k.
• Bonus opportunities.