Senior Clinical Research Specialist

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 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.

Opportunity Overview:

You will play a foundational role in the development of an industry-leading solution that harnesses clinical expertise and AI / ML to enhance acute inpatient utilization management clinical review quality and efficiency. You will apply your clinical expertise to audit acute inpatient authorizations to validate appropriate admission status, synthesize audit patterns, and help design automation algorithms.

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:

• Conduct condition-specific evidence-based literature reviews, and analyze and summarize clinical indication patterns for evaluating inpatient admission medical necessity
• Audit historical inpatient admission authorizations to validate appropriate admission status, and analyze and summarize audit patterns
• Work with MDs to develop proprietary guidelines for evaluating inpatient admission medical necessity 
• Collaborate with cross-functional teams to develop and optimize clinical review automation models and algorithms
• Advise on clinical review automation product build

Your background & requirements:

• Actively licensed and unencumbered Registered Nurse (RN), associate or bachelor’s degree
• Top performer with 10+ years of experience conducting payer utilization management clinical reviews or audits for acute inpatient authorizations for unplanned admissions
• Deep understanding of payer end-to-end acute inpatient authorization processes, including policies and procedures (e.g., CMS 2 midnight rule, MCG / Interqual guidelines)
• Independent, objective thinker that doesn’t just take things at face value 
• Extremely diligent with an absolute focus on quality
• Inclined to and adept at analyzing data to help solve problems  
• Values simplicity; adept at distilling complex clinical concepts into comprehensive, clear, and actionable frameworks
• Passion for and conceptual understanding of how AI / ML can be used to optimize UM
• Natural inclination to look for ways to improve the status quo
• Proficient in key applications (e.g., clinical review apps, spreadsheets, document processors)

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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