Associate Medical Director, Utilization Management Review

Cohere Health

29d • Remote

About The Position

We are looking for physicians who have expertise in Internal Medicine including medical and surgical clinical areas to deliver on Cohere’s program by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. Reporting to the Medical Director for Cohere Health, this is a critical role in a company that is rapidly scaling to impact millions of patients. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives.

Requirements

• Completed US-based residency program and fellowship in Internal Medicine
• Board certification as an MD or DO with a current unrestricted state license to practice medicine - reviewers must maintain necessary credentials to retain the position
• 5+ years of clinical practice beyond residency/fellowship in Internal Medicine
• Excels in a matrix organization
• Comfortable with technology - willing and able to learn new software tools
• Understanding of managed care regulatory structure and processes
• Detail-oriented, flexible, and able to work autonomously with little supervision
• 1+ years of managed care utilization review experience desirable
• Licensure in AZ, FL, MS, NC, ND, OK, OR, TX is highly desirable - you should be willing to obtain additional state licenses with Cohere's support

Nice To Haves

• Membership in national and/or regional specialty societies preferred
• Subspecialty fellowship training in Hematology Oncology, Medical Oncology, Gastroenterology, Endocrinology, Urology, or Sleep Medicine desirable

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

Benefits

• Fully remote opportunity with about 5% travel
• Medical, dental, vision, life, disability insurance, and Employee Assistance Program
• 401K retirement plan with company match; flexible spending and health savings account
• Up to 184 hours (23 days) of PTO per year + company holidays
• Up to 14 weeks of paid parental leave
• Pet insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 501-1,000 employees