Senior Clinical Research Specialist

Summary

Join Cohere Health, a fast-growing clinical intelligence company, and play a foundational role in developing an industry-leading solution that uses AI and clinical expertise to improve acute inpatient utilization management. You will conduct literature reviews, audit authorizations, work with MDs on guidelines, collaborate on automation models, and advise on product development. This role requires an active RN license, a bachelor's or associate's degree, and 10+ years of experience in payer utilization management clinical reviews for acute inpatient authorizations. Success in this position demands a deep understanding of payer processes, independent thinking, diligence, data analysis skills, and a passion for AI/ML optimization. Cohere Health offers a supportive and growth-oriented environment.

Requirements

• Actively licensed and unencumbered Registered Nurse (RN), associate or bachelor’s degree
• Top performer with 10+ years of experience conducting payer utilization management clinical reviews or audits for acute inpatient authorizations for unplanned admissions
• Deep understanding of payer end-to-end acute inpatient authorization processes, including policies and procedures (e.g., CMS 2 midnight rule, MCG / Interqual guidelines)
• Independent, objective thinker that doesn’t just take things at face value
• Extremely diligent with an absolute focus on quality
• Inclined to and adept at analyzing data to help solve problems
• Values simplicity; adept at distilling complex clinical concepts into comprehensive, clear, and actionable frameworks
• Passion for and conceptual understanding of how AI / ML can be used to optimize UM
• Natural inclination to look for ways to improve the status quo
• Proficient in key applications (e.g., clinical review apps, spreadsheets, document processors)

Responsibilities

• Conduct condition-specific evidence-based literature reviews, and analyze and summarize clinical indication patterns for evaluating inpatient admission medical necessity
• Audit historical inpatient admission authorizations to validate appropriate admission status, and analyze and summarize audit patterns
• Work with MDs to develop proprietary guidelines for evaluating inpatient admission medical necessity
• Collaborate with cross-functional teams to develop and optimize clinical review automation models and algorithms
• Advise on clinical review automation product build

Benefits

• #LI-Remote
• #BI-Remote