Cohere Health is hiring a
Physician Clinical Reviewer

Summary

Join Cohere Health as a Cardiology expert to review clinical information and apply evidence-based guidelines to determine the medical appropriateness of services. This is a critical role in a fast-growing company with a focus on improving patient care through AI and deep clinical expertise.

Requirements

• Completed US-based residency program in Internal Medicine and fellowship program in Cardiology
• Board certification as an MD or DO with a current unrestricted state license to practice medicine - reviewers must maintain necessary credentials to retain the position
• 5+ years of clinical practice beyond residency/fellowship in Internal Medicine or Cardiology

Responsibilities

• Support the clinical development team in reviewing the company’s clinical decision guidelines and evidence based literature
• Provide expert input on content and programs for influencing physicians in cardiovascular care to improve the quality of patient outcomes
• Provide timely medical reviews that meet Cohere’s stringent quality and timeliness parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen
• Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision
• Use correct templates for documenting decisions during case review
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
• Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers
• Support projects specific to building the team's clinical expertise and efficiency, as delegated
• Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated

Preferred Qualifications

• 1+ years of managed care utilization review experience desirable
• Membership in national and/or regional specialty societies
• Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX is highly desirable - you should be willing to obtain additional state licenses with Cohere’s support

Benefits

The salary range for this position $240,000 to $265,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus