Associate Medical Director, Cardiology at Cohere Health

United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

NoVisa

Healthcare, Medical Utilization ManagementIndustries

Requirements

U.S.-based residency in Internal Medicine and fellowship in Cardiology
Board certification (MD or DO) with an active, unrestricted state medical license; must maintain all required credentials
5+ years of clinical practice beyond residency/fellowship in Internal Medicine or Cardiology
1+ years of managed care utilization review experience desirable
Membership in national and/or regional specialty societies
Licensure in FL, MN, ND, or TX is highly desirable - willing to obtain additional state licenses with Cohere's support
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
Agree to cooperate fully with Cohere by obtaining state licenses or registrations when requested

Responsibilities

Support the clinical development team in reviewing the company’s clinical decision guidelines and evidence-based literature
Provide expert input on content and programs for influencing physicians in cardiovascular 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
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 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

Skills

Cardiology

Vascular Medicine

Evidence-Based Guidelines

Clinical Review

Peer-to-Peer Discussions

Medical Necessity Criteria

Clinical Decision Support

Documentation

Clinical Acumen

Cohere Health

Automates prior authorization in healthcare

About Cohere Health

Cohere Health improves the prior authorization process in healthcare, which requires providers to get approval from health plans before delivering certain services. Their platform, Cohere Unify, automates and streamlines these requests by integrating with electronic medical records and using technologies like optical character recognition and machine learning. This approach allows for faster decision-making and reduces delays in patient care. The goal is to make the prior authorization process more efficient, benefiting healthcare providers, health plans, and patients.

Boston, MassachusettsHeadquarters

2019Year Founded

$103.1MTotal Funding

LATE_VCCompany Stage

AI & Machine Learning, HealthcareIndustries

501-1,000Employees

Benefits

Health Insurance

401(k) Company Match

Performance Bonus

Remote Work Options

Risks

Increased competition from AI-driven startups like Abridge threatens market share.

Flat healthcare IT deal activity may impact future funding opportunities.

Dependency on Humana partnership poses risk if challenges arise in the relationship.

Differentiation

Cohere Health automates prior authorization, reducing delays and administrative burdens.

The Cohere Unify platform integrates with EMR and uses OCR for fax submissions.

Machine learning and AI enhance decision-making based on health plan policies.

Upsides

Humana expanded Cohere's platform use, showing trust and potential for more partnerships.

Cohere raised $50 million, indicating strong investor confidence and growth potential.

KLAS award recognition highlights effectiveness, attracting more healthcare providers.

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