Senior Inpatient Clinical Research Specialist

Summary

Join Cohere Health, a fast-growing clinical intelligence company, as a key member of a small, fast-paced team. You will play a foundational role in developing and delivering Cohere's inpatient product, leveraging your clinical expertise and AI knowledge to improve clinical review accuracy and efficiency. This position involves reviewing historical inpatient admission authorizations, synthesizing review patterns, and contributing to algorithm and ML model design for evaluating medical necessity. You will also consult on product design and serve as a go-to resource for best practices. Success in this role requires strong clinical expertise, analytical skills, and a passion for AI-driven optimization within the healthcare industry.

Requirements

• Registered Nurse (RN), associate or bachelor’s degree
• 10+ years of experience conducting payer UM reviews for acute inpatient authorizations
• 3+ years of experience in acute care hospital setting as a bedside nurse
• Clinical Rigor: Consistently performs high quality reviews, demonstrating strong command of complex cases
• Operational Expertise: Deep understanding of payer end-to-end inpatient UM workflows, regulatory requirements (e.g., CMS 2MN Rule), and guidelines (i.e., MCG, IQ)
• Analytical: Ability to identify patterns across reviews, summarize in a report, and generate actionable data-driven recommendations
• Communication: Proactive, comprehensive, clear, and concise (a)synchronous communication
• Technology Use: Proficient in key technology applications (e.g., MacBook, Slack, Google Suite, UM review tools)
• Leadership: Go-to resource for peers on best practices, and drives continuous improvement across the UM team
• Ownership: Takes ownership of work and is a self-starter
• Agility: Comfort operating in a fast-paced startup environment
• Perspective on AI: Passion for and conceptual understanding of how AI can be used to optimize UM
• Entrepreneurial: Natural inclination to look for ways to improve the status quo

Responsibilities

• Review historical inpatient admission authorizations
• Synthesize patterns across reviews
• Help design algorithms for evaluating inpatient admission medical necessity
• Help build ML models that read clinical notes
• Consult on review automation product design

Benefits

• Health insurance
• 401k
• Bonus