Jobs at Cohere Health

Supervise and develop a remote RN Reviewer team, manage daily productivity and timeliness reports, lead meetings, train new RNs, capture process improvements, and provide performance coaching to meet clinical operations metrics.

Optimize workforce performance for service and clinical operations by forecasting staffing, managing intraday operations for Intake and Clinical RN teams, monitoring productivity and queues, delivering performance reports and insights, identifying improvement and automation opportunities, leading daily operational meetings, and preparing leadership presentations.

Perform comprehensive MS-DRG and APR-DRG inpatient coding audits to validate DRG assignment and reimbursement, produce well-supported findings citing AHA Coding Clinic and ICD-10 guidelines, use DRG encoder tools to maximize overpayment identification, support provider appeals/disputes, meet quality and productivity standards, maintain HIPAA compliance, and stay current on coding and payment policy changes.

Perform evidence-based medical reviews for orthopedic spine cases, determine appropriateness of services, document decisions in workflow tools, meet turnaround times, and support operational and clinical improvement projects while communicating with team members and providers.

Design, implement, and validate data mapping, transformation, and integration solutions for payment integrity. Investigate and resolve complex data quality issues, create mapping specs and documentation, partner with stakeholders, and mentor analysts to improve data quality and automation.

Perform utilization management medical necessity reviews, draft compliant member and provider correspondence, consult with Medical Directors, ensure regulatory and accreditation compliance (NCQA/CMS), document determinations, meet productivity and turnaround goals, and support verbal notification workflows for timely clinical communication.

Physician role performing evidence-based utilization reviews and clinical determinations for medical appropriateness. Review and refine clinical decision guidelines, document decisions in workflow tools, conduct peer-to-peer discussions with treating providers, and support clinical content, operational improvements, and team efficiency. Maintain required medical credentials and comply with managed care regulatory expectations.

Lead Engineer responsible for end-to-end feature design, development, testing, and delivery of a cloud-based healthcare platform. Work full stack from database to frontend, design scalable data services and APIs, mentor junior engineers, ensure testing and security best practices, and deploy to modern cloud infrastructure.

Perform evidence-based utilization management reviews, prepare compliant member and provider correspondence, consult with Medical Directors, document clinical determinations, ensure NCQA/CMS regulatory compliance, meet productivity and turnaround targets, support verbal notifications, and drive process improvements.

Provide evidence-based medical utilization reviews for orthopedic spine cases, document decisions in Cohere workflows, conduct peer-to-peer provider discussions, meet turnaround and quality standards, and support clinical and operational improvement projects.

The Compliance Reporting Program Manager will coordinate compliance and regulatory reporting initiatives, manage workflows, and drive cross-functional collaboration for accurate and timely reporting.

As a Healthcare Analyst II, you will analyze healthcare data to optimize strategies, conduct quantitative analysis, and provide insights for clinical interventions, partnering with cross-functional teams.

The Strategic Medical Director leads clinical program design and strategy, collaborates with clients and cross-functional teams for effective care delivery, and monitors clinical performance.

The Payment Training Manager develops impactful training programs for medical auditors, translating complex coding insights and improving auditing accuracy through targeted education and flexible training solutions.

Lead and scale AI platform and agent engineering teams to build AI infrastructure, agent runtimes, MLOps/LLMOps, prompt and skills lifecycle management, and forward-deployed engineering for healthcare customers. Drive platform reliability, security, observability, enterprise integrations, and operational excellence to deploy AI-powered solutions at scale.

Lead and grow a distributed engineering team to build and scale AI platforms and agents for healthcare. Own technical strategy, data/retrieval/semantic architectures, ML model serving and MLOps, and deliver HIPAA-compliant, cloud-native systems in partnership with Product, Data Science, and Clinical teams.

The Staff Machine Learning Engineer will lead ML initiatives, develop ML systems, collaborate with cross-functional teams, and mentor junior engineers to optimize healthcare intake workflows using advanced machine learning techniques.

As a Claims Auditor, you will conduct MS-DRG and APR-DRG coding reviews, ensuring the accuracy of claims to maximize overpayment identification while adhering to coding guidelines and compliance regulations.

The Payment Selections Manager leads the identification and recovery of improper claim payments, collaborates with cross-functional teams, and improves payment integrity processes while conducting data analysis and audits.

The Medical Director will lead clinical program design and strategy, collaborating with teams to improve clinical offerings and client relationships in the healthcare sector.