Associate Medical Director, MSK Pain Management 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

UnknownVisa

HealthcareIndustries

Requirements

Completion of a US-based residency program in either Physical Medicine & Rehabilitation or Anesthesiology, with secondary board certification in Interventional Pain Management
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
Nice to have: 1+ years of managed care utilization review experience
Nice to have: Membership in national and/or regional specialty societies
Nice to have: Licensure in GA or TX (willing to obtain additional state licenses with Cohere's support)

Responsibilities

Provide timely medical reviews that meet Cohere’s stringent quality 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
Meet the appropriate turn-around times for clinical reviews
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

Pain Management

Interventional Pain Management

Physical Medicine & Rehabilitation

Anesthesiology

Evidence-Based Guidelines

Clinical Reviews

Peer-to-Peer Discussions

Clinical Documentation

Musculoskeletal (MSK)

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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