Cohere Health is hiring a
Physician Clinical Reviewer

Summary

Join Cohere Health as a physician with expertise in gastroenterology, hepatology, general surgery, bariatric surgery, or general medical topics. Support the clinical content team in reviewing clinical decision guidelines, provide expert input on content for improving patient outcomes, and conduct timely peer-to-peer discussions with treating providers. Report to the Medical Director for Cohere Health.

Requirements

• Completed US-based residency program in General Surgery
• Completed US-based fellowship in Gastroenterology
• 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 Gastroenterology, General Surgery, or Bariatric Surgery
• Able to multitask and manage tasks to completion on a timely basis and in an organized fashion
• Excels in a matrix organization
• Excellent communication - written and spoken
• Comfortable with technology - willing and able to learn new software tools
• Understanding of managed care regulatory structure and processes
• Detail-oriented, flexible, and able to work autonomously with little supervision

Responsibilities

• Support the clinical content team in reviewing the company’s clinical decision guidelines and evidence based literature
• Provide expert input on content for influencing physicians in medical 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 and knowledge of evidence based literature and medical society guidelines
• 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 medical necessity 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

• Salary range for this position is $245,000 to $265,000 annually
• As part of a total benefits package which includes health insurance, 401k and bonus