Cohere Health Offices

Manage day-to-day execution of assigned clinical program(s), translate strategy into actionable roadmaps, coordinate cross-functional teams (Clinical, Ops, Analytics, Client Success), monitor performance metrics, partner with analysts to drive data-informed improvements, support client reporting and reviews, and maintain program documentation and playbooks to ensure consistent, measurable outcomes.

Physician role performing evidence-based utilization reviews and clinical determinations for medical appropriateness. Review and refine clinical decision guidelines, document decisions in workflow tools, conduct peer-to-peer discussions with treating providers, and support clinical content, operational improvements, and team efficiency. Maintain required medical credentials and comply with managed care regulatory expectations.

Perform utilization management medical necessity reviews, draft compliant member and provider correspondence, consult with Medical Directors, ensure regulatory and accreditation compliance (NCQA/CMS), document determinations, meet productivity and turnaround goals, and support verbal notification workflows for timely clinical communication.