Note: The job is a remote job and is open to candidates in USA. Cohere Health provides clinical intelligence and AI-powered solutions that improve payer-provider decision-making and healthcare outcomes. The Manager, Clinical Integrity is a hands-on clinical and operational leader responsible for maintaining the integrity, scalability, and readiness of clinical programs and technology-enabled solutions, with a focus on utilization management, governance, testing, workflow optimization, and cross-functional collaboration.
Responsibilities
- Perform clinical reviews of our product, workflows, and programs to ensure they align with evidence-based practice, regulatory requirements, and client expectations
- Write and refine clinical requirements, user stories, and acceptance criteria for UM workflows, clinical decision support, and AI-enabled capabilities — and represent clinical integrity directly in sprint planning and design sessions with Product and Engineering
- Own operational readiness: run hands-on UAT, build test scripts and scenarios, document defects, and track readiness status for releases and client implementations
- Audit client commitments and SLAs against current product capabilities, flag gaps, and drive remediation
- Build and maintain governance documentation, SOPs, playbooks, and training materials that keep clinical workflows consistent across all lines of business
- Partner cross-functionally with Clinical Operations, Product, Engineering, Client Success, Compliance, Legal, and Clinical Strategy as the day-to-day point of contact for clinical integrity
- Support business growth by contributing clinical assessments, RFP/RFI responses, and feasibility reviews for prospective clients
Skills
- An RN, PT, OT, or SLP with an active, unrestricted clinical license and a Bachelor's degree in Nursing, Therapy, Healthcare Administration, or a related field
- 5+ years of progressive experience in Utilization Management, Clinical Operations, or health plan operations, including 2+ years in a leadership or supervisory capacity
- Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace UM, along with CMS regulations, NCQA accreditation, and delegation oversight
- Experienced partnering with Product and Technology teams to shape clinical workflows and digital solutions — you've influenced what gets built, not just used what was handed to you
- Comfortable with hands-on execution: writing documentation, testing workflows, building process tools, and managing the details
- A strong communicator who can build trust and influence stakeholders across functions without formal authority
- Bonus points for a Master's degree, experience with AI-enabled clinical workflows, familiarity with InterQual® or MCG®, a Lean/Six Sigma/Agile/PM certification, or prior UAT/QA experience in a tech environment
Benefits
- Fully remote opportunity with about 10% 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
- Bonus
Company Overview
Company H1B Sponsorship