Support the clinical content team in reviewing the company’s clinical decision guidelines and evidence based literature

Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes

Provide timely medical reviews that meet Cohere’s stringent quality and timeliness parameters

Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence based literature and medical society guidelines

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 medical necessity decisions during case review

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

Medical Director Utilization Management

Responsibilities

Qualification

Required

Preferred

Benefits

Company

Cohere Health

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