Clinical Reviewer, OT

We are looking for a licensed Occupational Therapist (OT) with expertise in occupational therapy to deliver on Cohere’s therapy programs by determining the medical appropriateness of services through reviewing clinical information and applying evidence-based guidelines. This role reports to a Managing Medical Director and is part of a review team that includes non-clinical intake specialists and nurses. This is a fast-paced environment suited for individuals who thrive in ambiguity, learn quickly, and communicate effectively with diverse backgrounds and perspectives.

Responsibilities

• Provide timely medical reviews that meet Cohere’s stringent quality parameters
• Make 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 accessibility and understanding for members and providers
• 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 outcomes, including feedback on alternate treatments 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
• Contribute to operational improvements and member/provider experience involving clinical review tasks, as delegated

Requirements

• Master’s degree in Occupational Therapy from an accredited program
• Active, unrestricted Occupational Therapist license in the state of practice
• 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

Benefits

• Fully remote opportunity with minimal travel
• Medical, dental, vision, life, and disability insurance, plus an Employee Assistance Program
• 401K retirement plan with company match; flexible spending and health savings accounts
• Flexible Time Off plus 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 agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the 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 operating in near real-time.