Note: The job is a remote job and is open to candidates in USA. Cohere Health is a healthcare technology company focused on improving payer-provider decision-making and care operations. The Clinical Process and Standards Director will lead clinical process improvement, delegated client initiatives, performance management, compliance efforts, workflow optimization, and cost-saving initiatives while collaborating with product and analytics teams.
Responsibilities
- Lead clinical process improvement initiatives and new delegated client initiatives
- Monitor performance and influence performance to client SLAs
- Conduct root cause analyses, develop remediation plan development and lead remediation execution for process variation, including CAPs
- Collaborate with product team and analytics team
- Understand current clinical operations processes deeply and assess performance to work instructions, P&Ps
- Ensure processes are compliant with regulations and accreditation requirements, including through process mapping and work instruction development
- Lead correspondence workflows
- Identify and drive cost-savings initiatives
Skills
- Bachelor's degree in healthcare and active clinical licensure in your state of residence (RN strongly preferred; PT/OT/SLP with a strong clinical background considered)
- 7+ years of leadership experience in healthcare operations, payer/provider communications, or utilization management
- Proven track record building new functions and creating operational structure in ambiguous, fast-paced environments
- Working knowledge of healthcare regulatory and accreditation requirements (CMS, NCQA, URAC)
- Strong process improvement, QA, and audit readiness experience, including policy/procedure and work instruction development
- Skilled with spreadsheets (Excel, Google Sheets) for data analysis and quantitative decision-making, and comfortable building decks (PPT, Google Slides)
- Experience with automation technologies, letter management systems, and workflow platforms; AI/ML exposure in utilization management a plus
- Ability to translate complex business requirements into clear, actionable specs for technical and operational teams
- Exceptional communication and stakeholder management skills, with the ability to influence without direct authority
- Independent, outcomes-oriented problem solver comfortable driving change in ambiguous environments
- Fully remote opportunity with about 10% travel
- Master's degree, Lean Six Sigma certification, or inpatient utilization management experience a plus
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