Clinical Policy Configuration Specialist

Cohere Health

1d • $65,000 - $80,000 • Remote

About The Position

Cohere Health is seeking a Clinical Policy Configuration Specialist to join its Clinical Operations team. The role ensures medical coverage policies are accurately configured, maintained, and compliant within Cohere’s platform, supporting consistent, high-quality clinical decision-making. The specialist partners with clinical experts, product, engineering, and operations teams to optimize policy implementation and usability, helping deliver evidence-based care at scale.

The position is fully remote with approximately 5% travel. It is not eligible for hire in California, New York, or Washington. The stated annual salary range is $65,000 to $80,000, with individual pay decisions based on qualifications, experience, skills, and internal alignment.

Requirements

• At least 2 years of related experience in utilization management, medical policy development, health technology assessment, or payer policy configuration.
• Strong understanding of medical coverage policies and prior authorization criteria.
• Familiarity with healthcare data structures and clinical coding, including ICD-10, HCPCS, and CPT.
• Knowledge of multiple software programs, including Microsoft Word, Excel, Google Drive, Confluence, and Jira.
• Strong attention to detail and experience with quality assurance and validation processes.
• Ability to work independently and as part of a team.
• Bachelor's degree in Nursing (BSN) or equivalent clinical background.
• Passion for improving the U.S. healthcare system and helping ensure patients receive the best care possible.
• Self-directed, confident, and able to thrive in a fast-paced startup environment.

Responsibilities

• Configure and maintain medical coverage policies in Cohere’s product platform to ensure accuracy, consistency, and compliance with industry standards.
• Conduct quality assurance reviews and test policy configurations for functionality and clinical appropriateness.
• Monitor medical coverage policy updates and adjust configurations to maintain compliance.
• Serve as a subject matter expert on medical coverage policies, providing guidance and support to internal teams and customers.
• Address internal and external customer inquiries and feedback about policy configurations, ensuring alignment with payers, providers, and reviewers.
• Collaborate with clinical experts, product managers, engineers, medical writers, and utilization management reviewers to optimize policy implementation and usability.

Benefits

• Medical, dental, vision, life, and disability insurance, plus an Employee Assistance Program.
• 401(k) retirement plan with company match.
• Flexible spending and health savings accounts.
• Flex Time Off and company holidays.
• Up to 14 weeks of paid parental leave.
• Pet insurance.
• Bonus included as part of the total benefits package.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level