Clinical Policy Configuration Specialist

The role

You will configure and maintain medical coverage policies within Cohere's product platform. You will partner with clinical, product, engineering, and operations teams to optimize policy implementation.

What you will do

• Configure and maintain medical coverage policies within Cohere's product platform
• Conduct quality assurance reviews and testing of policy configurations
• Monitor updates on medical coverage policies to adjust policies
• Serve as a subject matter expert on medical coverage policies
• Address internal and external customer inquiries and feedback regarding policy configurations
• Collaborate cross-functionally with clinical experts, product managers, engineers, medical writers, and utilization management reviewers

Required qualifications

• 2+ years of related experience working in utilization management, medical policy development, health technology assessment, or payer policy configuration
• Strong understanding of medical coverage policies and prior authorization criteria
• Familiarity with healthcare data structures, and clinical coding (ICD-10, HCPCS, CPT)
• Must be knowledgeable of multiple software programs (Microsoft Word, Excel, Google Drive, Confluence, Jira)
• Strong attention to detail with experience in quality assurance and validation processes
• Ability to work independently and as part of a team
• Bachelor's Degree in Nursing (BSN) or equivalent clinical background

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

Before you apply

• This role is not eligible for hire in: CA, NY, or WA
• Preliminary Phone Screening
• Meet your Hiring Manager
• Team Interview
• Cross Functional Interview

About the company

Cohere Health's clinical intelligence platform and agentic AI-powered solutions connect health plans' strategic goals and providers' needs. The company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction.