Manager, Clinical Operations

Opportunity Overview:

Cohere’s Clinical Operations team is responsible for ensuring that our healthcare partners are supported throughout their lifecycle of using the platform. The Manager, Clinical Operations position is a crucial role in our organization. In this role, you are responsible for coaching, mentoring, evaluating and developing the Reviewer team leadership and front line staff. The Manager will use established operational tools to ensure all Nurse staff and leaders are meeting or exceeding performance metrics and quality standards established by the leadership team.

As a Manager, you will work closely with the leadership team at Cohere and report to the Sr. Director/Director, Clinical Operations.  You will be responsible for providing daily operational guidance to the leadership and Nurse Reviewers to allow them to meet or exceed operational objectives and metrics.  You will leverage both your creative skills and communication skills to promote a high performing clinical team.

The Manager, Clinical Operations will be highly organized in order to plan daily operational activities and provide oversight of the Nurse Review teams. You will be responsible to work with the Sr. Director and leadership to develop the team’s future strategy to meet the organization’s goals.  You will use your professionalism, personality, and communication skills to inspire the team to meet or exceed all performance standards. At a growing organization, this is a position that offers the ability to make a substantive mark on the company and its partners with exponential growth opportunities.

What you’ll do:

• Oversee the Prior Auth Nurse Reviewers, Concurrent Review Nurses, or Appeals Specialists teams
• Mentor and develop team members in partnership with leadership
• Set daily team priorities and communicate expectations to staff
• Monitor timeliness reports to ensure cases meet turnaround time expectations
• Review nurse productivity metrics and provide ongoing performance feedback
• Lead weekly team meetings and biweekly 1:1s with direct reports
• Identify process improvement opportunities and collaborate with stakeholders to enhance efficiency
• Support recruiting, interviewing, onboarding, and training of new employees
• Maintain strong cross-functional relationships and provide leadership coverage as needed
• Track nurse productivity and update the Director on performance trends
• Advise leadership on process and system improvement opportunities
• Demonstrate and promote the core values of Cohere Health
• Support additional projects as needed

What you’ll need:

• Registered Nurse with an active and unencumbered license to practice
• 5+ years of supervisory/management experience
• Knowledge of NCQA/CMS requirements
• Experience using MCG, CMS NCDs/LCDs
• 3+ years Prior Authorization, Utilization Management and/or Appeals experience required
• Excellent computer skills and familiarity with a Mac.
• Experience supervising and training in a remote work environment

Pay & Perks:

💻 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 

🏝️ Up to 184 hours (23 days) of PTO per year + company holidays

👶 Up to 14 weeks of paid parental leave 

🐶 Pet insurance  

The salary range for this position is $95,000 to $110,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

Interview Process*:

1. Connect with Talent Acquisition for a Preliminary Phone Screening
2. Meet your Hiring Manager!
3. Behavioral Interview(s)
4. Case Study

*Subject to change

About Cohere Health:

Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.

With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes.

The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

We can’t wait to learn more about you and meet you at Cohere Health!

Equal Opportunity Statement: 

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all.  To us, it’s personal.

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