Medical Director, Clinical Policy

Company 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 leading edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health insurance plans covering over 15 million people, 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, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.

Opportunity Overview:

We are looking for an experienced physician for the role of  Medical Director, Healthcare Policy. This position will report to the Chief Medical Officer and will manage a team of medical writers, editors, and clinical policy specialists  in the research, development and implementation of medical coverage policies for various lines of business and for multiple health plan clients. This role will include client facing responsibilities including review of health plan client policies and presentation of recommendations.

This physician role will have a direct impact on the lives of our clinicians and their patients. You’ll play a central role in creating, maintaining, and communicating our provider facing and policy content, as well as ensuring content is configured within our product to optimize the clinical review of medical services based on current evidence based medical literature and standards of care.

Last but not least: People who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

What you will do:

• Editorial lead for clinical guidelines across various specialties 
• Manage the content pipeline / roadmap for clinical specialities 
• Create and enforce processes for developing, maintaining, and communicating medical policy and provider facing content. 
• Review, update, and document revisions to established medical policies and communicate to key stakeholders
• Responsible for reporting on policy coverage across Cohere’s customers and specialty lines 
• Assist Clinical Content departmental heads in strategic development and expansion of medical policies and provider facing content 
• Scope new content development projects that will be delivered on time, meet all requirements, and be of the highest quality 
• Manage a team of Medical Writers, Editors, and Clinical Policy Specialists

Your background & requirements:

• 5+ years in managed care or clinical strategy at a health plan, healthtech/ healthtech/solutions/services, topical consulting experience (partner-level), or a related payer-facing roles
• Medical Degree required and advanced degree in healthcare-related discipline preferred
• 5+ years of clinical practice beyond residency/fellowship  preferred
• 5+ years experience in clinical, regulatory, or scientific writing
• Thorough understanding of scientific research 
• Experience serving as the lead thinker / consulting partner, designing innovative clinical programs and interventions driving value for payers and their members
• Success in building credibility, influence and partner with key clients
• Demonstrated ability to work collaboratively and influence internal partner groups
• Strong communication and team management / interpersonal skills
• Strong leadership capabilities and ability to initiate and maintain cross-team relationships
• Prior experience with medical policy and content development
• Knowledge of medical coding terminologies (HCPCs, CPT, ICD-10)
• Working knowledge of Medicare (including NCDs/LCDs) , Commercial and Medicaid medical policies 
• Experience in reviewing clinical literature in order to understand implications of policy changes 
• Strong oral and written communication skills and the ability to interact within all levels of the organization 
• Ability to maintain high-quality outputs by developing and enforcing organizational standards and efficiencies 
• Ability to work in a fast-paced environment 
• You are passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible
• You are self-directed, confident, and thrive working in a fast-paced startup environment

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.

The salary range for this position is $250,000.00 to $300,000.00; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

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