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Define Ventures Partners

Clinical Training and Quality Specialist

Cohere Health

Cohere Health

Quality Assurance
United States
Posted on Saturday, January 20, 2024

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:

Clinical Training & Quality Specialist will work in support of the Service Operations Team at Cohere Health who conduct reviews and decision Prior Authorization requests for a patient’s medical insurance . You will implement clinical training and quality processes, scoring, and performance improvement data designed to improve operational efficiency while exceeding industry standards for quality performance and clinical guidance. You will provide support to all functions within the Training & Quality department. With a solid foundation in Training and Quality, you are expected to be flexible and nimble in your role to manage short- and long-term projects as well as dealing with day-to-day tasks. Cohere culture is one of partnership and ownership.

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:

  • 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
  • Meet required audit counts
  • Coach team members for improvement against quality metrics
  • Provide reporting on performance and key areas of quality improvement to Sr Leadership

Your background & requirements:

  • Active RN Licensure
  • Experience in the process of Coverage Determinations in Healthcare
    • NCQA and CMS standards for Utilization Management Authorization decisions
    • LCD/NCD Coverage Determination
  • Ability to conduct effective coaching sessions
  • Understanding of Adult Learning Theory and Training RN
  • Attention to detail

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 $70,000 to $80,000 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.