Offer summary

Qualifications:

10+ years of experience in inpatient utilization management (IP UM) at a health plan or IP revenue integrity at a hospital., Clinical degree (e.g., RN, MD, PharmD) preferred but not required., Proven track record in designing and overseeing clinical programs that impact IP utilization and spend., Strong grasp of regulatory requirements and clinical guidelines related to IP utilization..

Key responsabilities:

Monitor utilization trends and identify clinical drivers of unnecessary inpatient admissions.

Design targeted programs to improve medical necessity decision-making and reduce operational inefficiencies.

Define and evolve the clinical framework that aligns with evidence-based guidelines and payer priorities.

Act as a subject matter expert in strategic conversations with clients, ensuring alignment with health plan goals.

Job description

Company Overview:

Cohere Health is a fast-growing clinical intelligence company that’s improving lives at scale by promoting the best patient-specific care options, using cutting-edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health plans covering over 15 million lives, while our revenues and company size have quadrupled. That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include: 2023 and 2024 BuiltIn Best Place to Work; Top 5 LinkedIn™ Startup; TripleTree iAward; multiple KLAS Research Points of Light awards, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.

Opportunity Overview:

Working on a small, fast-paced team reporting into the Director of Commercial Strategy, you will help define the clinical strategy for Cohere’s inpatient solution, which combines deep clinical expertise and cutting edge AI to improve UM clinical review performance, reducing unnecessary IP admit utilization and operational burden. We’re seeking a seasoned health plan leader with extensive IP UM experience and a strong track record of reducing medical and admin spend through data-driven insights, clinical program development, and measurable outcomes. In this role, you’ll be responsible for identifying high-impact opportunities to improve IP UM, shaping innovative clinical programs in partnership with cross-functional teams, and continuously tracking performance to demonstrate value to our clients.

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:

Monitor utilization trends and identify clinical drivers of unnecessary IP admit utilization and operational inefficiencies
Help design targeted programs to improve medical necessity decision-making and reduce unnecessary IP admit admission utilization and operational inefficiencies
Define and evolve the clinical framework that underpins the product, ensuring alignment with evidence-based guidelines and payer strategic priorities
Translate clinical and regulatory requirements into clear inputs for analytics and product teams, supporting automated and scalable decision-making workflows
Help identify, define, and track meaningful KPIs – generating actionable insights and clearly communicating measurable value to clients
Act as a clinical and medical economics subject matter expert in strategic conversations with prospects and clients, reinforcing the credibility and differentiation of our solution
Collaborate with client clinical and medical economics leaders to support solution implementation, validate clinical integrity, and ensure alignment with health plan goals
Maintain deep knowledge of inpatient care trends, regulatory changes, and evolving payer strategies to continuously inform Cohere’s clinical approach

Your background & requirements:

10+ years of experience in IP UM at a health plan and / or IP revenue integrity at a hospital
Clinical degree (e.g., RN, MD, PharmD) preferred but not required
Proven track record designing and overseeing clinical programs that impact IP utilization and spend
Strong grasp of IP utilization and spend, regulatory requirements, and clinical guidelines
Experience collaborating with cross-functional teams (e.g., analytics, product, clinical operations) to translate clinical strategy into action
Adept at interpreting complex data and identifying trends to inform clinical program design and evaluation
Excellent communicator, able to convey clinical concepts clearly to both internal teams and external clients
Ability to operate in fast paced startup environment
Entrepreneurial by nature, always thinking about how to improve the status quo
Passion for and conceptual understanding of how AI can be used to optimize UM

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 $160,000 to $180,000 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.

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