Cohere Health · 1 month ago
Associate Medical Director, Utilization Management Review
United States
Full-time
Hybrid
Senior Level
$250K/yr - $265K/yr
5+ years expCohere Health is a rapidly scaling company that impacts millions of patients by delivering AI-powered healthcare solutions. They are seeking an Associate Medical Director for Utilization Management Review to determine the medical appropriateness of services, ensure quality patient outcomes, and support the clinical content team in improving clinical decision-making processes.
Consumer SoftwareHealth CareSaaSSoftware
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
Qualification
Required
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
Detail-oriented, flexible, and able to work autonomously with little supervision
Preferred
1+ years of managed care utilization review experience desirable
Membership in national and/or regional specialty societies preferred
Licensure in AZ, FL, MS, NC, ND, OK, OR, TX is highly desirable - you should be willing to obtain additional state licenses with Cohere's support
Subspecialty fellowship training in Hematology Oncology, Medical Oncology, Gastroenterology, Endocrinology, Urology, or Sleep Medicine desirable
Benefits
Medical, dental, vision, life, disability insurance, and Employee Assistance Program
401K retirement plan with company match; flexible spending and health savings account
Up to 184 hours (23 days) of PTO per year + company holidays
Up to 14 weeks of paid parental leave
Pet insurance
Company
Cohere Health
Cohere Health is a SaaS company that focuses on improving the efficiency and effectiveness of healthcare delivery.
501-1000 employees
H1B Sponsorship
Cohere Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (27)
2024 (21)
2023 (18)
2022 (10)
2021 (7)
2020 (2)
Funding
Current Stage
Late StageTotal Funding
$186.1MKey Investors
Temasek HoldingsDeerfield ManagementPolaris Partners
2025-05-14Series C· $90M
2024-02-01Series C· $50M
2021-04-13Series B· $36.1M
Leadership Team
Siva Namasivayam
Chief Executive Officer
Robert Shepardson
Chief Financial Officer
Recent News
Company data provided by crunchbase