Cohere Health Medical Director Orthopedic Surgery at Coherehealth responsible for determining medical appropriateness of orthopedic services using evidence-based guidelines. Provide timely medical reviews and clinical determinations.
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
Qualification
Licensure in AZ🩺 Medical🏝️ Flex Time Off + company holidays
Required
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 - reviewers must maintain necessary credentials to retain the position
5+ years of clinical practice beyond residency/fellowship
1+ years of managed care utilization review experience preferred
Membership in national and/or regional specialty societies preferred
Licensure in AZ, FL, MN, ND, OR, or TX is highly desirable - you should be willing to obtain additional state licenses with Cohere's support
💻 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
🏝️ Flex Time Off + company holidays
👶 Up to 14 weeks of paid parental leave
The salary range for this position is $240,000 to $260,000 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.