Remote Physician Clinical Reviewer, Gastroenterology/General Surgery

Summary

Join Cohere Health, a rapidly growing clinical intelligence company, as an Internal Medicine physician. You will play a critical role in ensuring the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. This fast-paced position requires strong communication, adaptability, and the ability to work effectively in a matrix organization. You will collaborate with the clinical content team, conduct medical reviews, and communicate with providers. Success in this role demands expertise in Internal Medicine, strong technology skills, and a commitment to high-quality patient care. Cohere Health offers a competitive salary and benefits package.

Requirements

• Completed US-based residency program and fellowship in Internal Medicine
• 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
• Excels in a matrix organization
• Comfortable with technology - willing and able to learn new software tools
• Understanding of managed care regulatory structure and processes
• Consultant agrees to cooperate fully with Cohere by obtaining state licenses or registrations when requested by Cohere

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

• 2+ years of managed care utilization review experience desirable
• Membership in national and/or regional specialty societies

Benefits

• Health insurance
• 401k
• Bonus