Medical Reviewer, PA

Cohere Health

5d • $120,000 - $135,000 • Remote

About The Position

We are looking for an orthopedic spine Physician Assistant to help deliver on Cohere’s musculoskeletal and orthopedic programs by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. The physician assistant should have previous experience in managing spine conditions in an office setting as well as assisting on spine cases in the operating room. Reporting to the Managing Medical Director MSK Spine and Ortho for Cohere Health, and part of the review team that includes non-clinical intake specialists, nurses and physicians, this is a critical role in a Series B 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, and communicate effectively with people of different backgrounds and perspectives. Training and supervision will be provided. This is a remote-first role that may require travel to Boston, MA for new hire onboarding and occasional in-person team meetings and company events.

Requirements

• Graduate of an accredited Physician Assistant program
• Current NCCPA certification (PA-C) and active, unrestricted Physician Assistant license in at least one U.S. state
• 3+ years of clinical experience supporting orthopedic spine surgeons and/or neurosurgeons treating spine conditions

Nice To Haves

• Utilization management, prior authorization, or medical review experience a plus
• Membership in organizations such as the AAPA or specialty spine organizations

Responsibilities

• Provide timely medical reviews that meet Cohere’s stringent quality parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen
• 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 decisions during case review
• Meet the appropriate turn-around times for clinical reviews
• 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
• Clearly communicate with team members

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: Mid Level
• Education Level: Associate degree