Note: The job is a remote job and is open to candidates in USA. Cohere Health is a company that delivers AI-powered solutions to streamline access to quality care. They are seeking a Clinical Quality and Training Specialist to support clinical quality measurement and performance improvement initiatives, focusing on inpatient clinical reviews and operational efficiency.
Responsibilities
- Conduct quality audits of inpatient clinical determinations to ensure alignment with clinical guidelines and quality standards
- Analyze QA findings and translate insights into actionable recommendations for operational leaders and cross-functional partners
- Provide coaching and feedback to improve clinical decision accuracy, guideline adherence, and overall team performance
- Develop and maintain SOPs, job aids, workflow documentation, and training materials for inpatient review processes
- Facilitate onboarding and ongoing training for Clinical teams using adult learning principles and subject-matter expertise
- Partner cross-functionally with Product, Clinical, Client Services, and Operations to implement workflow updates, monitor quality trends, and report performance insights to leadership
Skills
- Active RN license
- 2+ years of experience reviewing inpatient utilization management / coverage determinations, with strong familiarity with NCQA and CMS guidelines
- Experience applying clinical guidelines (e.g., LCD/NCD) to medical necessity or authorization decisions
- Experience conducting quality audits, performance reviews, or QA processes in a clinical operations or utilization management environment
- Ability to deliver coaching, feedback, or training to improve clinical decision accuracy and guideline adherence
- Strong analytical skills with experience identifying quality trends, root causes, and opportunities for improvement
- Excellent written and verbal communication skills with the ability to partner effectively with operational and cross-functional stakeholders
- Proficiency with tools such as Google Workspace (Sheets, Docs, Forms) and comfort working with data, dashboards, or quality reporting
Benefits
- Fully remote opportunity with about 5% travel
- Medical, dental, vision, life, disability insurance, and Employee Assistance Program
- 401K retirement plan with company match; flexible spending and health savings account
- Flexible Time Off + Company Holidays
- Up to 14 weeks of paid parental leave
- Pet insurance
Company Overview
Cohere Health is a SaaS company that focuses on improving the efficiency and effectiveness of healthcare delivery. It was founded in 2019, and is headquartered in Boston, Massachusetts, USA, with a workforce of 501-1000 employees. Its website is https://coherehealth.com.