INACTIVE
Full-Time
Associate Medical Director
Utilization Management Reviewer
Posted on 12/14/2023
AI-driven prior authorization solutions in healthcare
AI & Machine Learning
Senior
Remote in USA
Required Skills
Communications
Requirements
- Completed US-based residency program in Internal Medicine or General Surgery
- Board certification as an MD or DO with a current unrestricted state license to practice medicine
- 5+ years of clinical practice beyond residency/fellowship in Internal Medicine or General Surgery
Responsibilities
- 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
Cohere Health provides intelligent prior authorization solutions, including Cohere Unify™ and Cohere Complete™, leveraging AI and machine learning to streamline the process and align physicians and health plans on evidence-based care paths, ultimately improving patient outcomes and reducing administrative expenses. These technologies have been recognized on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.
Company Stage
Series C
Total Funding
$122.2M
Headquarters
Boston, Massachusetts
Founded
2019
Growth & Insights
Headcount
6 month growth
↑ 7%1 year growth
↑ 23%2 year growth
↑ 75%INACTIVE