Clinical Process and Standards Director

Cohere Health

3d • $160,000 - $180,000 • Remote

About The Position

We are seeking a Clinical Process and Standards Director to join our Clinical Operations team. In this role, you will work closely with the clinical operations leadership team at Cohere and report to the Sr. Director of Clinical Process and Standards. As part of the Clinical Operations organization, this role will support new implementation and change initiatives to ensure quality, consistency and scalability in a fast-paced, rapidly expanding environment. This is an opportunity to make an impact on the way the clinical ops team members perform their roles by reducing unnecessary variation, simplifying and incorporating automation, and collaborating with the product team to leverage technology to support.

Requirements

• 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

Nice To Haves

• Master's degree
• Lean Six Sigma certification
• inpatient utilization management experience

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

Benefits

• 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

What This Job Offers

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