Clinical Program Director

Summary

Join Cohere Health as a clinical strategist for inpatient solutions, leveraging your expertise to define clinical strategies and improve UM clinical review performance. You will design targeted programs to reduce unnecessary IP admissions, translate clinical requirements for product teams, and track KPIs to demonstrate value to clients. Collaborate with cross-functional teams and clients, maintaining deep knowledge of inpatient care trends and payer strategies. This role requires 10+ years of experience in IP UM at a health plan or IP revenue integrity at a hospital, a clinical degree is preferred but not required. The salary range is $160,000 to $180,000 annually, with a benefits package including health insurance, 401k, and bonus.

Requirements

• 10+ years of experience in IP UM at a health plan and / or IP revenue integrity at a hospital
• Proven track record designing and overseeing clinical programs that impact IP utilization and spend
• Strong grasp of IP utilization and spend, regulatory requirements, and clinical guidelines
• Experience collaborating with cross-functional teams (e.g., analytics, product, clinical operations) to translate clinical strategy into action
• Adept at interpreting complex data and identifying trends to inform clinical program design and evaluation
• Excellent communicator, able to convey clinical concepts clearly to both internal teams and external clients
• Ability to operate in fast paced startup environment
• Entrepreneurial by nature, always thinking about how to improve the status quo
• Passion for and conceptual understanding of how AI can be used to optimize UM

Responsibilities

• Monitor utilization trends and identify clinical drivers of unnecessary IP admit utilization and operational inefficiencies
• Help design targeted programs to improve medical necessity decision-making and reduce unnecessary IP admit admission utilization and operational inefficiencies
• Define and evolve the clinical framework that underpins the product, ensuring alignment with evidence-based guidelines and payer strategic priorities
• Translate clinical and regulatory requirements into clear inputs for analytics and product teams, supporting automated and scalable decision-making workflows
• Help identify, define, and track meaningful KPIs – generating actionable insights and clearly communicating measurable value to clients
• Act as a clinical and medical economics subject matter expert in strategic conversations with prospects and clients, reinforcing the credibility and differentiation of our solution
• Collaborate with client clinical and medical economics leaders to support solution implementation, validate clinical integrity, and ensure alignment with health plan goals
• Maintain deep knowledge of inpatient care trends, regulatory changes, and evolving payer strategies to continuously inform Cohere’s clinical approach

Preferred Qualifications

Clinical degree (e.g., RN, MD, PharmD)

Benefits

• Health insurance
• 401k
• Bonus