Note: The job is a remote job and is open to candidates in USA. Cohere Health provides clinical intelligence and AI-powered solutions that connect health plans and providers to improve healthcare decision-making and outcomes. The Correspondence and Clinical Process Manager will support clinical process improvement, implementation, compliance, performance management, and process scalability across Clinical Operations while collaborating with product and analytics teams.
Responsibilities
- Support clinical process improvement initiatives and new delegated client initiatives
- Monitor performance and influence performance to client SLAs
- Conduct root cause analyses, support remediation plan development and 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
- Support development and update of work instructions
- Ensure processes are compliant with regulations and accreditation requirements
- Support optimization of letters process and template tracking
Skills
- Bachelor's degree in healthcare and active clinical licensure in your state of residence (RN, PT/OT/SLP considered)
- 3+ years of experience in utilization management operations
- Working knowledge of healthcare regulations and accreditation requirements (CMS, Medicaid, JCAHO)
- Skilled with spreadsheets (Excel, Google Sheets) for data analysis and quantitative decision-making, and comfortable building decks (PPT, Google Slides)
- Hands-on experience implementing process improvements, with policy/procedure or work instruction development a plus
- Independent, outcomes-oriented problem solver comfortable operating in ambiguous, fast-paced environments
- Strong communication and stakeholder management skills, with the ability to influence without direct authority
- Leadership experience in healthcare operations, payer/provider communications, or utilization management a plus
- Experience with automation technologies and workflow platforms; AI/ML exposure in utilization management a plus
- Lean Six Sigma certification, change management experience, or experience translating operational needs into business requirements 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