Clinical Reviewer, DPT

We are looking for a Doctor of Physical Therapy (DPT) with expertise in musculoskeletal and orthopedic programs to determine the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. This role reports to the Medical Director MSK Spine and Ortho and is part of a review team that includes non-clinical intake specialists and nurses. This is a fast-paced environment that favors individuals who can learn quickly, handle ambiguity, and communicate effectively with diverse backgrounds and perspectives.

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 members and providers can easily reference and understand decisions
• Use correct templates for documenting decisions during case review
• Meet appropriate turn-around times for clinical reviews
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and 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 interactions with Cohere teammates and providers
• Support projects aimed at 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

Requirements

• Doctor of Physical Therapy (DPT) from a CAPTE-accredited physical therapy program
• Active, unrestricted Physical Therapist license in the state of practice (or eligibility for licensure)
• 5 or more years of direct clinical patient care experience
• Familiarity with facilities rendering care in PT, OT, SLP
• 1+ years of managed care utilization review experience, preferably in a utilization management organization within a Medicare, Commercial, or Medicaid payor organization
• Membership in national and/or regional specialty societies preferred

Benefits

• Fully remote opportunity with minimal travel
• Medical, dental, vision, life, and disability insurance, plus 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

Pay

The salary range for this position is $95,000 to $105,000 annually, as part of a total benefits package that includes health insurance, 401k, and bonus. Individual pay decisions are based on qualifications, experience level, skillset, and internal alignment.

Cohere Health’s clinical intelligence platform and AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing speed, cost, and quality of care. The company improves collaboration and reduces burden, delivering up to 8x ROI and 94% provider satisfaction. With the acquisition of ZignaAI, Cohere has enhanced its platform with a Payment Integrity Suite, including Cohere Validate™, an AI-driven clinical and coding validation solution.