Clinical Training and Quality Specialist

Summary

Join Cohere Health as a Clinical Training & Quality Specialist and contribute to improving lives at scale by promoting patient-specific care options. You will implement clinical training and quality processes, scoring, and performance improvement data to improve operational efficiency while exceeding industry standards for quality performance and clinical guidance.

Requirements

• Active RN Licensure
• Experience in the process of Coverage Determinations in Healthcare NCQA and CMS standards for Utilization Management Authorization decisions
• LCD/NCD Coverage Determination
• Ability to conduct effective coaching sessions
• Understanding of Adult Learning Theory and Training RN
• Attention to detail

Responsibilities

• Audit Individual Operations team members on Clinical decisions against clinical guidelines
• Facilitate training for the RN Clinical team on Cohere Clinical decisioning process and job functions
• Meet required audit counts
• Coach team members for improvement against quality metrics
• Provide reporting on performance and key areas of quality improvement to Sr Leadership