Clinical Integrity Manager

The role

This role executes and maintains the integrity, scalability, and operational readiness of clinical programs and technology-enabled solutions. The manager translates clinical strategy into scalable processes and ensures clinical capabilities meet regulatory requirements and evidence-based standards.

What you will do

• Perform clinical reviews of product, workflows, and programs
• Write and refine clinical requirements, user stories, and acceptance criteria
• Represent clinical integrity in sprint planning and design sessions
• Run hands-on UAT, build test scripts, and document defects
• Audit client commitments and SLAs against product capabilities
• Build and maintain governance documentation, SOPs, playbooks, and training materials
• Partner cross-functionally with Clinical Operations, Product, Engineering, Client Success, Compliance, Legal, and Clinical Strategy
• Contribute clinical assessments, RFP/RFI responses, and feasibility reviews

Required qualifications

• RN, PT, OT, or SLP with an active, unrestricted clinical license
• Bachelor's degree in Nursing, Therapy, Healthcare Administration, or a related field
• 5+ years of progressive experience in Utilization Management, Clinical Operations, or health plan operations
• 2+ years in a leadership or supervisory capacity
• Knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace UM
• Knowledge of CMS regulations, NCQA accreditation, and delegation oversight
• Experience partnering with Product and Technology teams to shape clinical workflows and digital solutions
• Ability to perform hands-on execution including writing documentation and testing workflows

Nice to have

• Master's degree
• Experience with AI-enabled clinical workflows
• Familiarity with InterQual® or MCG®
• Lean/Six Sigma/Agile/PM certification
• Prior UAT/QA experience in a tech environment

Benefits

• Medical, dental, vision, life, disability insurance
• 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

• Preliminary Phone Screening
• Meet your Hiring Manager
• Behavioral Interview(s)

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 through an enterprise approach that streamlines payer-provider decision-making.