Medical Director Utilization Management

About the role

Cohere Health is seeking physicians with expertise in Internal Medicine, including medical and surgical clinical areas, to determine the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. Reporting to the Managing Medical Director, this is a critical role in a 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, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives. 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.

Responsibilities

• Support the clinical content team in reviewing the company's clinical decision guidelines and evidence based literature
• Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes
• Provide timely medical reviews that meet Cohere's stringent quality and timeliness parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence based literature and medical society guidelines
• 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 medical necessity decisions during case review
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to 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 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

Requirements

• Completed US-based residency program and fellowship in Internal Medicine
• Board certification as an MD or DO with a current unrestricted state license to practice medicine – reviewers must maintain necessary credentials to retain the position
• 5+ years of clinical practice beyond residency/fellowship in Internal Medicine
• Excels in a matrix organization
• Comfortable with technology – willing and able to learn new software tools
• Understanding of managed care regulatory structure and processes
• Detail-oriented, flexible, and able to work autonomously with little supervision

Qualifications

• 1+ years of managed care utilization review experience desirable
• Membership in national and/or regional specialty societies preferred
• Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX is highly desirable – you should be willing to obtain additional state licenses with Cohere's support

Benefits

• Fully remote opportunity with about 10% travel
• 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

Pay

The salary range for this position is $240,000 to $250,000 annually, as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.