Opportunity Overview: We are looking for physicians who have expertise in PM&R, Family Practice, Pediatrics, or Internal 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 Managing Medical Director for Cohere Health, this is a critical role in a company that is rapidly scaling to impact millions of patients. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives.
What you'll do:- 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
What you'll need:- Completed US-based residency program in PM&R, Family Practice, Pediatrics, or Internal Medicine
- Board certification as an MD or DO with a current unrestricted state license to practice medicine - reviewers must maintain necessary credentials to retain the position
- 5+ years of clinical practice beyond residency/fellowship in above specialties
- Understanding of Therapy programs (PT / OT / SLP) on outpatient and inpatient basis
- Excels in a matrix organization
- 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
- 1+ years of managed care utilization review experience in Therapy (PT/OT/SLP) highly desirable
- Licensure in AR, MO, MN, NC, IN, TX, NE is highly desirable - you should be willing to obtain additional state licenses with Cohere's support
Pay & Perks: Fully remote opportunity with about 5% travel
Medical, dental, vision, life, disability insurance, and Employee Assistance Program
401K retirement plan with company match; flexible spending and health savings account
Flex Time Off + company holidays
Up to 14 weeks of paid parental leave
Pet insurance
The salary range for this position is $210,000 - $260,000 annually; 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.
Interview Process*:- Connect with Talent Acquisition for a Preliminary Phone Screening
- Meet your Hiring Manager!
- Behavioral Interview(s)
*Subject to change
