Manager, Clinical Escalations

The role

You will build and lead the Escalations Program within Clinical Operations. You will manage client and provider complaints, ensure regulatory compliance, and lead one direct report.

What you will do

• Design and implement a formal escalation framework
• Triage and manage client and provider complaints
• Monitor open escalations to ensure follow-up and resolution
• Track and enforce compliance with regulatory and contractual response times
• Handle high-sensitivity executive escalations
• Provide timely communication to internal leaders on high-risk escalations
• Manage, coach, and support one direct report
• Develop dashboards and reporting to track escalation trends and performance
• Partner with cross-functional teams to address systemic issues
• Create and maintain standard operating procedures and escalation playbooks

Required qualifications

• Bachelor's degree in healthcare
• Active clinical licensure in state of residence (RN, PT/OT/SLP considered)
• 3+ years of experience in utilization management operations
• Experience in external client, provider, and/or member communications
• Knowledge of healthcare regulations and accreditation (CMS, Medicaid, JCAHO)
• Proficiency with spreadsheet functions, including data analysis and drawing quantitative conclusions
• Experience implementing process improvements
• Ability to function independently and navigate ambiguity to build a cross-functional program
• Strong problem-solving skills with a customer focus

Nice to have

• Familiarity with ticketing or project management software (e.g., CRM, JIRA, Monday.com)
• Demonstrated success implementing new programs
• People leadership experience
• Experience managing escalations in a multi-client or multi-health-plan environment
• Familiarity with root cause analysis (RCA) methodologies and corrective action plan (CAP) development

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

• 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, resulting in up to 8x ROI and 94% provider satisfaction.