Clinical Training & Quality Specialist

The role

You will implement clinical quality measurements, scoring, and performance improvement data to improve operational efficiency. You will guide and support the training and quality needs of Clinical Operations through auditing, coaching, and developing training materials.

What you will do

• Audit Individual Operations team members on Clinical decisions against clinical guidelines
• Translate QA findings into clear insights and recommendations for operational leaders and cross-functional partners
• Develop and deploy structured coaching sessions based on audit findings
• Create and ensure accuracy of SOPs, job aids, workflow guides, and new product readiness materials
• Facilitate onboarding and ongoing upskilling sessions for Clinical teams
• Lead QA/Training side of project implementations
• Partner with Product, Clinical, Client Services, and Operations to validate workflow changes
• Support change management by communicating process updates
• Serve as a subject matter expert and advisor to frontline leaders
• Manage multiple concurrent priorities with independence, ownership, and accountability

Required qualifications

• Active RN Licensure
• 2+ years experience in the process of Coverage Determinations in Healthcare
• NCQA and CMS standards for Utilization Management Authorization decisions
• LCD/NCD Coverage Determination Ability to conduct effective coaching sessions
• Understanding of Adult Learning Theory and Training RN
• Attention to detail
• Communication skills - verbal and written
• Data collection, management and analysis
• Problem analysis and problem solving
• Planning and organizing
• Effective interaction with stakeholders

Nice to have

• Proficiency with Google Workspace (Sheets, Docs, Forms); ability to build pivot tables and create charts or dashboards is a plus
• Experience identifying performance trends and root causes through data is a plus
• Experience using quality management systems and conducting structured QA audits is a plus
• Experience facilitating coaching sessions and giving constructive feedback is a ples
• Understanding of Adult Learning Theory and Training is a plus

Benefits

• Medical, dental, vision, life, disability insurance, and Employee Assistance Program
• 401K retirement plan with company match
• flexible spending and health savings account
• Flexible 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, WA
• Preliminary Phone Screening
• Hiring Manager Interview
• Leadership Interview
• Cross Functional Interview

About the company

Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. The company works with over 660,000 providers and handles over 12 million prior authorization requests annually.