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Define Ventures Partners

Compliance Quality Auditor

Cohere Health

Cohere Health

Legal, Quality Assurance
Posted on Tuesday, September 12, 2023

Company Overview:

Cohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patient’s healthcare experience, both in and out of the doctors office. Founded in August, 2019, we are obsessed with eliminating wasteful friction patients and doctors experience in areas that have nothing to do with health and treatment, particularly for diagnoses that require expensive procedures or medications. To that end, we build software that is expressly designed to ensure the appropriate plan of care is understood and expeditiously approved, so that patients and doctors can focus on health, rather than payment or administrative hassles.

Opportunity Overview:

This role will be primarily responsible for performing clinical compliance and quality audits to ensure compliance with federal and state regulations, NCQA, URAC and client contractual requirements. This role will also assist with data collection, analysis and reporting for process improvement efforts.

The Compliance Quality Auditor will plan, coordinate, and conduct compliance audits at the direction of the Manager of Compliance and Audit, Director of Compliance Quality, Compliance Officer and Quality Committee. Scope includes reviewing/ auditing of all CMS-required data tables, utilization management processing/determinations and associated clinical rationale against applicable rules and regs. Will also include quality assurance functions and quality improvement. Cross-functional role with responsibilities in compliance auditing and quality improvement.

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:

  • Ensures compliance with regulations by examining and analyzing records, reports, operating practices, and documentation; will provide recommendations for improvement and coaching as necessary
  • Completes audit work papers and memorandums by documenting audit findings
  • Presents audit findings to the Quality Committee or other leadership body
  • Maintains excellent documentation of all audits, methodologies employed, results, corrective action plans implemented, and monitoring
  • Communicate audit progress and findings by preparing reports, have discussions with management, and providing information in meetings
  • Analyzes quality assurance and compliance data and assists in preparing reports.
  • Assists in designing and implementing solutions to quality management issues.
  • Maintains a strong working knowledge of state and federal legislation, statutes, and regulations, as well as various client service level agreements
  • Other tasks as assigned by the Compliance Officer

Your background & requirements:

  • Completion of an accredited Registered Nursing Program (Bachelor’s or higher degree preferred)
  • Active Registered Nursing License (any state)
  • Minimum 2 years in a healthcare auditing or operations role, preferably in Utilization Management clinical review/case management for MSK, orthopedic conditions, cardiology

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.