Clinical Policy Configuration Specialist

United Statesfull timeRemote

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entry

$65k–$80k

H1B: yes

Cohere Health The Clinical Policy Configuration Specialist at Cohere Health configures and maintains medical coverage policies within the platform to ensure accuracy and compliance. They collaborate cross-functionally to optimize policy implementation and support clinical decision-making.

Responsibilities

Configure and maintain medical coverage policies within Cohere’s product platform to ensure accuracy, consistency, and compliance with industry standards.
Conduct quality assurance reviews and testing of policy configurations to validate functionality and clinical appropriateness.
Monitor updates on medical coverage policies to adjust policies and maintain compliance.
Serve as a subject matter expert on medical coverage policies, providing guidance and support to internal teams and customers.
Address internal/external customer inquiries and feedback regarding policy configurations, ensuring alignment with payers, providers, and reviewers.
Collaborate cross-functionally with clinical experts, product managers, engineers, medical writers, and utilization management reviewers to optimize policy implementation and usability.

Qualification

You are self-directed🩺 Medical

Required

2+ years of related experience working in utilization management, medical policy development, health technology assessment, or payer policy configuration.
Strong understanding of medical coverage policies and prior authorization criteria.
Familiarity with healthcare data structures, and clinical coding (ICD-10, HCPCS, CPT).
Must be knowledgeable of multiple software programs (Microsoft Word, Excel, Google Drive, Confluence, Jira)
Strong attention to detail with experience in quality assurance and validation processes.
Ability to work independently and as part of a team
You are passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible
You are self-directed, confident, and thrive working in a fast-paced startup environment
Bachelor's Degree in Nursing (BSN) or equivalent clinical background
💻 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