Jobs at Cohere Health

• Cultivate a deep understanding of Cohere’s clinical content, UM products and clinical programs and use analytics to produce insights to drive program effectiveness and value for internal business partners and clients
• Work with multiple types of healthcare data to build and maintain analytical and reporting solu...

• Review healthcare policy documentation and data for discrepancies and missing information and resolve discrepancies
• Enter healthcare policy data including policy text, procedure codes, and diagnosis codes into Cohere Health’s product

• Deeply understand Cohere’s clinical content, products, services and clinical programs and how Cohere’s solutions intersect with healthcare providers’ workflow and patients’ care journey.
• Direct a team of data analysts and clinical informatics leads, ensuring high collaboration with clinicians, program leaders, data scientists, and actuaries to deliver insights for data-driven clinical programs.

• Research, Build, Execute and Optimize auto decisioning strategy for new client implementations
• Work with multiple types of healthcare data to build and maintain analytical and reporting solutions to support strategy and program decision making

• Gain a deep understanding of Cohere’s product and our health plan partners
• Provide daily operational direction to the intake staff. This includes interviewing new hires, training, coaching, mentoring, quality auditing, implementation and oversight of quality improvement plans identified based on trends and other process improvements

• Lead the technical roadmap for the Decisioning & Content team, working alongside cross-functional teams to deliver high-impact deterministic rules-based and AI-driven healthcare automation solutions.
• Design, develop, and optimize scalable rules engines that can dynamically handle complex decisi...

• Support the clinical development team in reviewing the company’s clinical decision guidelines and evidence based literature
• Provide expert input on content and programs for influencing physicians in cardiovascular care to improve the quality of patient outcomes

• Partner internally and with our brokers on benefits, including annual renewals and Open Enrollment
• Review and approve benefit enrollments and assist employees with questions and guidance on benefit offerings

• Serve as the bridge between clinicians, data science, engineering in planning, implementing, validating, executing and maintaining optimization care strategy
• Utilize data, industry trends, and best practices to support the development of consulting methodologies that will facilitate the use of health information technology

• Work as part of a cross-functional team to develop project requirements, identifying data collection sources for project needs. Responsible for milestone setting from a data science perspective
• Develop research questions and undertake data exploration to understand who our product users are, how they get value out of Cohere, and where we can develop our product to bring greater value and simplify healthcare

• Develop and Execute Release Strategies: Design and implement release management strategies, policies, and processes to deliver high-quality, timely, and efficient software.
• Drive Software Quality Initiatives: Champion a quality culture across the organization by establishing best practices for quality assurance, automated testing, and continuous improvement in software development processes.

• Provide thought leadership & strategic thinking to design and enablement of Cohere’s enterprise data warehouse, data lakes and datamarts
• Lead our enterprise master data initiatives to ensure single, accurate, and consistent view of key entities like patients and providers, including standard definitions for our clinical and operational needs

• Audit Individual Operations team members on Clinical decisions against clinical guidelines
• Facilitate training for the RN Clinical team on Cohere Clinical decisioning process and job functions

• Lead Generation & Prospecting:

Proactively identify and research potential clients within the healthcare industry, focusing on health insurance companies, and other risk-bearing providers that could benefit from our solutions.
Utilize various tools and platforms (e.g., LinkedIn, CRM, cold calling, email campaigns, referrals, etc.) to generate and qualify leads.
Develop and maintain a comprehensive understanding of the target market segments, buyer personas, key stakeholders, and decision-makers within prospect organizations.

• Design and execute support for change management plans to ensure inclusive, complete, successful implementation of new processes, programs and pilots with our clients
• Creation of workflow process flows, Standard Operating Policies & Procedures, playbooks and training material

• Provide timely medical reviews that meet Cohere’s stringent quality parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen

• Work cross-functionally to design appropriate data use capabilities across a wide breadth of business needs
• Develop, implement, and monitor day-to-day operations of data management team

• Work on fast-paced, collaborative, autonomous, agile teams to build and enhance a growing software platform together
• Responsible for end to end feature releases and platform enhancements

• Strategic Leadership: Develop and maintain Cohere Health's technology architecture strategy, ensuring it aligns with business objectives and supports our mission to improve prior authorization, utilization management and healthcare processes.
• Architectural Vision: Lead the design and evolution of the company’s technology architecture, ...

• 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