[Remote] Clinical Policy Configuration Specialist

Note: The job is a remote job and is open to candidates in USA. Cohere Health is a company focused on optimizing healthcare processes through its clinical intelligence platform. They are seeking a Clinical Policy Configuration Specialist to ensure medical coverage policies are accurately configured and compliant, collaborating with clinical experts and cross-functional teams to enhance policy implementation.

Responsibilities

• Configure and maintain medical coverage policies within Cohere’s product platform to ensure accuracy, consistency, and compliance with industry standards
• Conduct quality assurance reviews and testing of policy configurations to validate functionality and clinical appropriateness
• Monitor updates on medical coverage policies to adjust policies and maintain compliance
• Serve as a subject matter expert on medical coverage policies, providing guidance and support to internal teams and customers
• Address internal/external customer inquiries and feedback regarding policy configurations, ensuring alignment with payers, providers, and reviewers
• Collaborate cross-functionally with clinical experts, product managers, engineers, medical writers, and utilization management reviewers to optimize policy implementation and usability

Skills

• 2+ years of related experience working 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)
• Must be knowledgeable of multiple software programs (Microsoft Word, Excel, Google Drive, Confluence, Jira)
• Strong attention to detail with experience in quality assurance and validation processes
• Ability to work independently and as part of a team
• You are passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible
• You are self-directed, confident, and thrive working in a fast-paced startup environment
• Bachelor's Degree in Nursing (BSN) or equivalent clinical background

Benefits

• Fully remote opportunity with about 5% travel
• 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

Company Overview