Associate Medical Director, Orthopedic Surgery at Cohere Health

United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Medical Utilization ManagementIndustries

Requirements

Completed US-based residency program in Orthopedic Surgery
Board certification by appropriate specialty board as an MD or DO with a current unrestricted state license to practice medicine (must maintain necessary credentials to retain the position)
5+ years of clinical practice beyond residency/fellowship

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
Use correct templates for documenting decisions during case review
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

Key technologies and capabilities for this role

Orthopedic SurgeryMedical ReviewEvidence-Based GuidelinesClinical DocumentationPeer-to-Peer DiscussionsBoard Certification

Questions & Answers

Common questions about this position

What is the salary range for the Associate Medical Director, Orthopedic Surgery position?

The salary range is $250,000 to $270,000 annually, as part of a total benefits package which includes health coverage.

Is this a remote position, and is there any travel required?

This is a fully remote opportunity with about 5% travel.

What are the must-have qualifications for this role?

Candidates must have completed a US-based residency in Orthopedic Surgery, board certification as an MD or DO with a current unrestricted state license, and 5+ years of clinical practice beyond residency/fellowship.

What benefits are offered for this position?

Benefits include medical, dental, vision, life, disability insurance, Employee Assistance Program, 401K with company match, flexible spending and health savings accounts, up to 184 hours of PTO per year plus holidays, up to 14 weeks of paid parental leave, and pet insurance.

What kind of work environment and team structure can I expect?

This is a fast-paced environment in a Series B company rapidly scaling, reporting to the Medical Director MSK Orthopedics and Spine, and part of a review team that includes non-clinical intake specialists and nurses; it favors people who learn quickly, are hands-on, handle ambiguity, and communicate effectively.

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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