Clinical Policy Configuration Specialist
Cohere HealthPrior Authorization company
United States$65,000 to $80,000 annuallyMid
Temasek
Deerfield
Flare Capital Partners
Define Ventures
Operations & Strategy
About the role
TL;DR
Configure and maintain clinical policies for Cohere's platform, ensuring accuracy and compliance.
- •We are seeking a Clinical Policy Configuration Specialist to join our Clinical Operations team.
- •In this role, you will ensure medical coverage policies are accurately configured, maintained, and compliant within Cohere’s platform, directly supporting high-quality, consistent clinical decision-making.
- •Key Responsibilities 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 and maintain compliance.
- •Serve as a subject matter expert on medical coverage policies.
- •Address internal/external customer inquiries and feedback regarding policy configurations.
- •Requirements 2+ years of related experience 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).
- •Knowledgeable of multiple software programs (Microsoft Word, Excel, Google Drive, Confluence, Jira).
- •Strong attention to detail with experience in quality assurance and validation processes.
Required skills
JiraConfluenceExcel
Domain expertise
healthtech
Benefits & perks
Fully remote opportunity, Medical insurance, Dental insurance, Vision insurance, Life insurance, Disability insurance, Employee Assistance Program, 401K retirement plan with company match, Flexible spending account, Health savings account, Flex Time Off, Company holidays, Paid parental leave, Pet insurance
Tech stack
ExcelConfluenceJira